Healthcare Provider Details

I. General information

NPI: 1952137895
Provider Name (Legal Business Name): PRESCOTT VILLAGE NURSING & REHABILITATION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2024
Last Update Date: 09/09/2024
Certification Date: 09/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1030 SCOTT DR
PRESCOTT AZ
86301-4737
US

IV. Provider business mailing address

1030 SCOTT DR
PRESCOTT AZ
86301-4737
US

V. Phone/Fax

Practice location:
  • Phone: 928-778-2450
  • Fax: 928-778-5251
Mailing address:
  • Phone: 928-778-2450
  • Fax: 928-778-5251

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: DAVID GARETZ
Title or Position: CFO
Credential:
Phone: 323-987-5954