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General NPI Number Information
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NPI Number | 1255860763
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Entity Type | Organization
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Legal Business Name | WELBROOK SENIOR LIVING FLAGSTAFF LLC
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Dates
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Enumeration Date | 06/08/2017
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Last Update Date | 07/12/2018
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Provider Practice Location Address
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Address Line | 1521 N PINE CLIFF DR
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City | FLAGSTAFF
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State | AZ
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Zip | 86001
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Country | US
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Telephone | 801-683-6565
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Fax |
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Provider Business Mailing Address
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Address Line | 450 S 400 E STE 200
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City | BOUNTIFUL
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State | UT
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Zip | 84010-5094
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Country | US
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Telephone | 801-683-6565
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MATT RASBAND
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Credential |
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Telephone | 801-683-6565
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number |
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License Number State |
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