MEDICARE: LA POSADA AT PARK CENTRE INC

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	251V00000X	Voluntary or Charitable Agency	AL0553D	AZ
2	261QA0600X	Adult Day Care Clinic/Center

General Provider Information

NPI Number	:	1730466962
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LA POSADA AT PARK CENTRE INC

Provider Business Mailing Address
First Line	:	780 S PARK CENTRE AVE
Second Line	:
City	:	GREEN VALLEY
State	:	AZ
Zip	:	85614-5127
Country	:	US
Telephone Number	:	520-625-2273
Fax Number	:

Provider Business Practice Location Address
First Line	:	780 S PARK CENTRE AVE
Second Line	:
City	:	GREEN VALLEY
State	:	AZ
Zip	:	85614-5127
Country	:	US
Telephone Number	:	520-625-2273
Fax Number	:

Authorized Official
Title or Position	:	DIR. OF HEALTHCARE SERVICES
Name	:	MR. STEVEN KOLNACKI
Credential	:
Telephone Number	:	520-648-8380

Provider Enumeration Date	:	11/16/2011
Last Update Date	:	03/07/2023

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