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General NPI Number Information
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NPI Number | 1588246953
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Entity Type | Individual
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Provider Name | RYAN SIMONSON
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Gender | Male
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Dates
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Enumeration Date | 04/26/2021
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Last Update Date | 09/25/2022
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Provider Practice Location Address
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Address Line | 7 MILES WEST OF PINON
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City | PINON
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State | AZ
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Zip | 86510-0358
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Country | US
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Telephone | 928-890-9310
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 358
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City | PINON
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State | AZ
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Zip | 86510-0358
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Country | US
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Telephone | 928-890-9310
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0401X
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Taxonomy Name | Comprehensive Outpatient Rehabilitation Facility (CORF)
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License Number |
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Taxonomy #2
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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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Taxonomy #3
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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Taxonomy #4
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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Taxonomy #5
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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Taxonomy #6
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Taxonomy Code | 253J00000X
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Taxonomy Name | Foster Care Agency
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Taxonomy #7
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Taxonomy Code | 261QD1600X
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Taxonomy Name | Developmental Disabilities Clinic/Center
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License Number |
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Taxonomy #8
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Taxonomy Code | 251G00000X
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Taxonomy Name | Community Based Hospice Care Agency
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License Number |
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Taxonomy #9
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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