# LDRKAIR

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- **Entity:** Organization
- **Status:** Active
- **Other names:** The Carriage House on West Garden Lane
- **Organization subpart:** No

## Provider details

- **NPI number:** 1386971877
- **Authorized official:** MR. LARRY DOUGLAS MATYAS (OWNER)
- **Authorized official phone:** (928) 536-7935

## Contact information

- **Practice address:** 395 W GARDEN LN, SNOWFLAKE, AZ 85937-6218
- **Practice address phone:** (928) 536-7935
- **Practice address fax:** (928) 536-5444
- **Mailing address:** 395 W GARDEN LN, SNOWFLAKE, AZ 85937-6218
- **Mailing address phone:** (928) 536-7935
- **Mailing address fax:** (928) 536-5444

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 311ZA0620X | Adult Care Home Facility | ALC-4533 | AZ | Yes |

## Other

- **Enumeration date:** 11/04/2009
- **Last updated:** 11/04/2009