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General NPI Number Information
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NPI Number | 1376410563
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Entity Type | Organization
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Legal Business Name | ARIZONA SENIORS 2024 LLC
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Dates
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Enumeration Date | 10/21/2025
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Last Update Date | 10/21/2025
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Provider Practice Location Address
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Address Line | 5408 HIGHWAY 260
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City | LAKESIDE
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State | AZ
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Zip | 85929-5791
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Country | US
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Telephone | 928-532-4600
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Fax |
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Provider Business Mailing Address
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Address Line | 5408 HIGHWAY 260
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City | LAKESIDE
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State | AZ
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Zip | 85929-5791
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Country | US
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Telephone | 928-532-4600
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | MICHAEL KENNEDY
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Credential |
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Telephone | 702-401-0005
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State |
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