Healthcare Provider Details

I. General information

NPI: 1912833815
Provider Name (Legal Business Name): BLUE IRIS ASSISTED LIVING, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2026
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7105 N WILLIAMSON VALLEY RD
PRESCOTT AZ
86305-8996
US

IV. Provider business mailing address

7105 N WILLIAMSON VALLEY RD
PRESCOTT AZ
86305-8996
US

V. Phone/Fax

Practice location:
  • Phone: 928-778-0002
  • Fax: 928-778-7485
Mailing address:
  • Phone: 928-778-0002
  • Fax: 928-778-7485

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: MRS. CATHERINE EXCELL
Title or Position: OWNER/MANAGER
Credential: MANAGER
Phone: 928-273-2262