Healthcare Provider Details

I. General information

NPI: 1457996233
Provider Name (Legal Business Name): EMERALD SPRINGS OF YUMA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2019
Last Update Date: 04/06/2020
Certification Date: 04/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1475 S 46TH AVE
YUMA AZ
85364-4010
US

IV. Provider business mailing address

1107 HAZELTINE BOULEVARD, BOX 36
CHASKA MN
55318-1009
US

V. Phone/Fax

Practice location:
  • Phone: 928-900-0130
  • Fax: 928-329-7717
Mailing address:
  • Phone: 952-361-8935
  • Fax: 952-361-8060

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: MR. JAMES A. WEICHERT
Title or Position: BOARD MEMBER
Credential:
Phone: 612-618-1682