# KINGMAN NO 1 LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Desert Highlands Care Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1184656175
- **Authorized official:** CLIFF SHIRRELL (VICE PRESIDENT)
- **Authorized official phone:** (573) 471-1276

## Contact information

- **Practice address:** 1081 KATHLEEN AVE, KINGMAN, AZ 86401-3918
- **Practice address phone:** (928) 753-5580
- **Mailing address:** PO BOX 1210, SIKESTON, MO 63801-1210

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | NCI306 | AZ | Yes |

## Other

- **Enumeration date:** 07/07/2006
- **Last updated:** 01/03/2017

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 633182 | — | AZ |