Healthcare Provider Details

I. General information

NPI: 1164326419
Provider Name (Legal Business Name): VHG WINSLOW AZ OPCO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2026
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

826 W DESMOND ST
WINSLOW AZ
86047-2321
US

IV. Provider business mailing address

2 RITZ CARLTON DR STE 202
DANA POINT CA
92629-4245
US

V. Phone/Fax

Practice location:
  • Phone: 928-289-4678
  • Fax:
Mailing address:
  • Phone: 949-355-3795
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. BRYAN FOULGER
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 949-355-3795