Provider Demographics
NPI:1932998143
Name:MIDKIFF, AIMEE SUSANNE (CCG)
Entity type:Individual
Prefix:
First Name:AIMEE
Middle Name:SUSANNE
Last Name:MIDKIFF
Suffix:
Gender:F
Credentials:CCG
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7859 E LAS FLORES AVE
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:86314-5540
Mailing Address - Country:US
Mailing Address - Phone:929-277-0884
Mailing Address - Fax:928-277-0946
Practice Address - Street 1:7859 E LAS FLORES AVE
Practice Address - Street 2:
Practice Address - City:PRESCOTT VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:86314-5540
Practice Address - Country:US
Practice Address - Phone:929-277-0884
Practice Address - Fax:928-277-0946
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-05
Last Update Date:2025-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAL12778H310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility