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NPI Code Detail

MEDICARE: NORTHERN ARIZONA SENIOR LIVING COMMUNITY, L.L.C.

MEDICARE: NORTHERN ARIZONA SENIOR LIVING COMMUNITY, L.L.C.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1310400000XAssisted Living FacilityALC-2517AZ
2314000000XSkilled Nursing FacilityNCI-2515AZ

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1504698OTHERHEALTH CHOICE ARIZONA
2504698OTHERMERCY CARE PLAN
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4504698OTHERIHS-FFS
5AZ0206980OTHERAZBCBS OF AZ MANAGED CARE
6504698OTHEREVERCARE SELECT
7MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1679515449
Entity Type Code : Organization
Provider Name (Legal Business Name) : NORTHERN ARIZONA SENIOR LIVING COMMUNITY, L.L.C.
Provider Business Mailing Address
First Line : 1107 HAZELTINE BLVD
Second Line : SUITE 200
City : CHASKA
State : MN
Zip : 55318-1009
Country : US
Telephone Number : 952-361-8000
Fax Number : 952-361-8060
Provider Business Practice Location Address
First Line : 3150 N WINDING BROOK RD
Second Line :
City : FLAGSTAFF
State : AZ
Zip : 86001-0972
Country : US
Telephone Number : 928-774-7106
Fax Number : 928-213-0831
Authorized Official
Title or Position : AUTHORIZED OFFICIAL
Name : RANDALL W BENSON
Credential :
Telephone Number : 952-361-8000
Provider Enumeration Date : 06/13/2006
Last Update Date : 02/21/2020

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1609072941 — SANDRA ANN RYAN M.A., CCC-LP
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1225229735 — ELIZABETH ANNE FEROZ MARANO DPT
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