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General NPI Number Information
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NPI Number | 1972005395
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Entity Type | Organization
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Legal Business Name | GRANITE VIEW ADULT CARE HOME LLC
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Dates
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Enumeration Date | 03/01/2018
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Last Update Date | 03/01/2018
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Provider Practice Location Address
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Address Line | 7105 WILLIAMSON VALLEY ROAD
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City | PRESCOTT
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State | AZ
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Zip | 86305
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Country | US
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Telephone | 928-778-0002
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Fax | 928-778-1207
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Provider Business Mailing Address
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Address Line | PO BOX 11805
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City | PRESCOTT
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State | AZ
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Zip | 86304
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Country | US
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Telephone | 928-778-0002
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Fax | 928-778-1207
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Authorized Official
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Title or Position | MANAGER
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Name | MS. KAREN S JONES
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Credential |
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Telephone | 928-533-4472
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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 | AL8343H
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License Number State | AZ
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