KINGMAN SENIOR LIVING, LLC (NPI# 1730653361) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1730653361 |
| Entity Type | Organization |
| Organization Name | KINGMAN SENIOR LIVING, LLC |
| Practice Address |
3600 Peterson Rd Kingman AZ 86409-3276 |
| Mailing Address |
2020 W Rudasill Rd Tucson AZ 85704-7800 |
| Practice Telephone | 9286811050 |
| Enumeration Date | 2019-01-16 |
| Last Update Date | 2019-01-16 |
| Authorized Official Name | DAVID FRESHWATER (AUTHORIZED OFFICIAL) |
| Authorized Official Telephone | 5207974000 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 310400000X | Assisted Living Facility | Nursing & Custodial Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| AZ | AL9549C | 05 |
| Other Name | Type Code |
|---|---|
| White Cliffs Senior Living | Doing Business As Name - Organization |
| Street Address |
3600 PETERSON RD |
| City | KINGMAN |
| State | AZ |
| Zip Code | 86409-3276 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437695731 | Medical Laboratory Specialty, Inc | Clinical Medical Laboratory | 3636 St, Kingman, AZ 86409 | 2017-01-10 |
| 1003219007 | Premier Home Health Agency | Home Health | 3555 Western Ave, Kingman, AZ 86409 | 2014-10-03 |
| 1558774984 | Fernando Velez | Pharmacist | 2003 Roy Rogers Way, Kingman, AZ 86409 | 2014-06-03 |
| 1013227834 | Route 66 Cab Inc | Taxi | 3595 E Us Highway 66, Kingman, AZ 86409 | 2010-10-14 |
| 1740503374 | Route 66 Cab Inc. | Taxi | 3595 East Hwy 66, Kingman, AZ 86409 | 2010-03-10 |
| 1649409145 | Arizona Cvs Stores, L.L.C. | Durable Medical Equipment & Medical Supplies | 3501 Stockton Hill Rd, Kingman, AZ 86409 | 2009-07-07 |
| 1790922896 | Jack Cheng-tsung Hou | Urology | 1739 E Beverly Ave Ste 106, Kingman, AZ 86409 | 2009-01-12 |
| 1710184726 | Michele F Epstein | Internal Medicine | 3571 N Moore Street, Kingman, AZ 86409 | 2007-07-02 |
| 1013118306 | Conchita O Mercado | Dentist | 1101 Riata Valley Rd, Kingman, AZ 86409 | 2007-05-31 |
| 1366585945 | Deering Therapy Services Ltd | Occupational Therapist | 1841 Morrow Ave, Kingman, AZ 86409 | 2007-02-14 |
| Find all providers in zip 86409 | ||||
| Taxonomy Code | 310400000X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Assisted Living Facility |
| A facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548550437 | Jeri Wilhite Williams | Assisted Living Facility | 3862 N Melody St, Kingman, AZ 86409-3305 | 2011-04-12 |
| 1669604542 | The Lingenfelter Center | Assisted Living Facility | 1025 Sunrise Ave, Kingman, AZ 86401-6825 | 2009-08-11 |
| 1134286859 | Kingman County Retirement Home Association | Assisted Living Facility | 750 W Washington Ave, Kingman, KS 67068-2000 | 2007-01-02 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235730508 | Gheorghe Patrutescu | Assisted Living Facility | 16134 N 72nd Ln, Peoria, AZ 85382-4937 | 2020-11-03 |
| 1942800966 | Yibu Liu | Assisted Living Facility | 3569 E Utopia Rd, Phoenix, AZ 85050-3967 | 2020-10-28 |
| 1386243269 | Harmony House Tucson LLC | Assisted Living Facility | 12651 E Speedway Blvd, Tucson, AZ 85748-2060 | 2020-10-21 |
| 1710586664 | Sunland Springs Memory Care, LLC | Assisted Living Facility | 2415 S Signal Butte Rd, Mesa, AZ 85209-2107 | 2020-10-21 |
| 1487253860 | Ronald Jingco Calaguas | Assisted Living Facility | 2432 W Portobello Ave, Mesa, AZ 85202-7871 | 2020-10-18 |
| 1992303374 | Azi House LLC | Assisted Living Facility | 1200 W Chapala Dr, Tucson, AZ 85704-4521 | 2020-10-16 |
| 1609474030 | Fisher Family Home LLC | Assisted Living Facility | 2927 W Redfield Rd, Phoenix, AZ 85053-7712 | 2020-10-16 |
| 1235736687 | Ana's Assisted Living Home, LLC | Assisted Living Facility | 13238 N 35th St, Phoenix, AZ 85032-6110 | 2020-10-07 |
| 1205433844 | Angelic Care LLC | Assisted Living Facility | 15247 W Wethersfield Rd, Surprise, AZ 85379-9177 | 2020-10-07 |
| 1689281347 | Gilbert Al Partners, Lp | Assisted Living Facility | 1445 E Willis Rd, Gilbert, AZ 85297-7352 | 2020-09-28 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.