# PHOENIX MOUNTAIN NURSING CENTER INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1902899933
- **Authorized official:** MR. C BRUCE HARKINS (ASSISTANT TREASURER CFO)
- **Authorized official phone:** (816) 734-0533

## Contact information

- **Practice address:** 13232 N TATUM BLVD, PHOENIX, AZ 85032-6459
- **Practice address phone:** (602) 996-5200
- **Practice address fax:** (602) 996-6160
- **Mailing address:** 13232 N TATUM BLVD, PHOENIX, AZ 85032
- **Mailing address phone:** (602) 996-5200
- **Mailing address fax:** (602) 996-6160

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | NC1326 | AZ | Yes |

## Other

- **Enumeration date:** 08/24/2005
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 1298610001 | DMERC | — |
| 01 | — | 4307000M | CIGNA HEALTH CARR OF AZ | — |
| 05 | — | 447228 | — | AZ |
| 01 | — | AZ0402260 | BLUE CROSS BLUE SHIELD | AZ |