MEDICARE: SENTIENT HARBOR LLC

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
1	310400000X	Assisted Living Facility
2	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1689325854
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SENTIENT HARBOR LLC

Provider Business Mailing Address
First Line	:	PO BOX 2543
Second Line	:
City	:	SAINT JOHNS
State	:	AZ
Zip	:	85936-2543
Country	:	US
Telephone Number	:	928-388-6466
Fax Number	:

Provider Business Practice Location Address
First Line	:	725 N 13TH W
Second Line	:
City	:	SAINT JOHNS
State	:	AZ
Zip	:	85936-4849
Country	:	US
Telephone Number	:	928-388-6466
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. KATELYN N STUMBAUGH
Credential	:
Telephone Number	:	928-388-6466

Provider Enumeration Date	:	01/10/2022
Last Update Date	:	12/05/2023

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Directions to “SENTIENT HARBOR LLC ” Practice Location

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