Organization
BOULDER GARDENS ASSISTANT LIVING, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CARL ZIMMERMAN (SENIOR VICE PRESIDENT)
(520) 352-3019
Entity
Organization
Contact information
Practice address
860 DOUGHERTY ST, PRESCOTT, AZ 86305-1841
(928) 778-9667
(520) 393-1044
Mailing address
150 N LA CANADA DR, GREEN VALLEY, AZ 85614-3129
(520) 352-3018
(520) 393-1044
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
AL1494C
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
AL1494C
STATE LICENSE
AZ
Enumeration date
11/30/2012
Last updated
11/30/2012
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