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General NPI Number Information
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NPI Number | 1831121813
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Entity Type | Organization
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Legal Business Name | HAVASU NURSING CENTER 2 INC
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Dates
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Enumeration Date | 07/07/2006
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Last Update Date | 08/31/2017
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Provider Practice Location Address
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Address Line | 3576 KEARSAGE DR
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City | LAKE HAVASU CITY
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State | AZ
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Zip | 86406-9115
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Country | US
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Telephone | 928-453-1500
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1210
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City | SIKESTON
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State | MO
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Zip | 63801-1210
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Country | US
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Telephone | 573-471-1276
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Fax | 573-472-8504
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | CLIFF SHIRRELL
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Credential |
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Telephone | 573-471-1276
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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 | NC1-355
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License Number State | AZ
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