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General NPI Number Information
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NPI Number | 1568882991
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Entity Type | Organization
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Legal Business Name | SIERRA BLANCA REHABILITATION LLC
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Dates
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Enumeration Date | 04/24/2014
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Last Update Date | 04/24/2014
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Provider Practice Location Address
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Address Line | 3401 LOCKWOOD DR
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City | LAKESIDE
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State | AZ
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Zip | 85929-5613
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Country | US
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Telephone | 928-368-2060
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Fax | 928-368-2085
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Provider Business Mailing Address
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Address Line | 3401 LOCKWOOD DR
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City | LAKESIDE
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State | AZ
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Zip | 85929-5613
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Country | US
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Telephone | 928-368-2060
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Fax | 928-368-2085
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Authorized Official
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Title or Position | ADMINISTRATOR/OWNER
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Name | MATTHEW K MEYER
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Credential |
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Telephone | 480-652-5628
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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 | NCI 2691
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License Number State | AZ
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