Provider Demographics
NPI:1417783580
Name:PRESCOTT VALLEY NURSING & REHABILITATION LLC
Entity type:Organization
Organization Name:PRESCOTT VALLEY NURSING & REHABILITATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:GARETZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-987-5954
Mailing Address - Street 1:3380 N WINDSONG DR
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:86314-2262
Mailing Address - Country:US
Mailing Address - Phone:928-775-0045
Mailing Address - Fax:928-775-2752
Practice Address - Street 1:3380 N WINDSONG DR
Practice Address - Street 2:
Practice Address - City:PRESCOTT VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:86314-2262
Practice Address - Country:US
Practice Address - Phone:928-775-0045
Practice Address - Fax:928-775-2752
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-13
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility