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General NPI Number Information
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NPI Number | 1033213053
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Entity Type | Organization
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Legal Business Name | NORTHLAND CARES
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Dates
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Enumeration Date | 09/11/2006
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Last Update Date | 05/16/2025
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Provider Practice Location Address
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Address Line | 3188 N WINDSONG DR STE A
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City | PRESCOTT VALLEY
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State | AZ
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Zip | 86314-1220
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Country | US
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Telephone | 928-776-4612
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Fax | 928-771-1767
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Provider Business Mailing Address
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Address Line | 3188 N WINDSONG DR STE A
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City | PRESCOTT VALLEY
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State | AZ
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Zip | 86314-1220
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Country | US
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Telephone | 928-776-4612
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Fax | 928-771-1767
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | JOHNNY MARTINEZ
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Credential |
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Telephone | 928-776-4612
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251V00000X
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Taxonomy Name | Voluntary or Charitable Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 1033213053
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License Number State | AZ
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