Healthcare Provider Details

I. General information

NPI: 1164429759
Provider Name (Legal Business Name): INFINIA AT SHOWLOW
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 E HUNT ST
SHOW LOW AZ
85901-7920
US

IV. Provider business mailing address

2401 E HUNT ST
SHOW LOW AZ
85901-7920
US

V. Phone/Fax

Practice location:
  • Phone: 928-537-5333
  • Fax: 928-537-1762
Mailing address:
  • Phone: 928-537-5333
  • Fax: 928-537-1762

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberNCI-373
License Number StateAZ

VIII. Authorized Official

Name: SCOTT ROBERTSON
Title or Position: OWNER
Credential:
Phone: 801-295-8000