MEDICARE: INFINIA AT DOUGLAS

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	314000000X	Skilled Nursing Facility	NCI-388	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1831195460
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INFINIA AT DOUGLAS

Provider Business Mailing Address
First Line	:	1400 N SAN ANTONIO AVE
Second Line	:
City	:	DOUGLAS
State	:	AZ
Zip	:	85607-2434
Country	:	US
Telephone Number	:	520-364-7937
Fax Number	:	520-805-9146

Provider Business Practice Location Address
First Line	:	1400 N SAN ANTONIO AVE
Second Line	:
City	:	DOUGLAS
State	:	AZ
Zip	:	85607-2434
Country	:	US
Telephone Number	:	520-364-7937
Fax Number	:	520-805-9146

Authorized Official
Title or Position	:	OWNER
Name	:	SCOTT ROBERTSON
Credential	:
Telephone Number	:	801-295-8000

Provider Enumeration Date	:	06/28/2005
Last Update Date	:	08/22/2020

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Directions to “INFINIA AT DOUGLAS ” Practice Location

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