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General NPI Number Information
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NPI Number | 1669604542
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Entity Type | Organization
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Legal Business Name | THE LINGENFELTER CENTER
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Dates
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Enumeration Date | 08/11/2009
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Last Update Date | 08/16/2013
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Provider Practice Location Address
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Address Line | 1025 SUNRISE AVE
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City | KINGMAN
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State | AZ
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Zip | 86401-6825
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Country | US
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Telephone | 928-718-2021
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Fax | 928-718-4856
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Provider Business Mailing Address
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Address Line | 1025 SUNRISE AVE
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City | KINGMAN
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State | AZ
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Zip | 86401-6825
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Country | US
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Telephone | 928-718-2021
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Fax | 928-718-4856
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Authorized Official
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Title or Position | CHAIRMAN OF THE BOARD
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Name | FRED B LINGENFELTER
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Credential |
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Telephone | 928-718-4852
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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 | ALH4336
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License Number State | AZ
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