Organization
SLO AUSTIN HOUSE, LLC
Active
Organization
SLO AUSTIN HOUSE, LLC
Active
Other names
Austin House Assisted Living
Organization subpart
No
Provider details
NPI number
Authorized official
JANYA RICCA (EXECUTIVE DIRECTOR)
(928) 634-4278
Entity
Organization
Contact information
Practice address
195 S WILLARD ST, COTTONWOOD, AZ 86326-4123
(928) 634-4278
Mailing address
195 S WILLARD ST, COTTONWOOD, AZ 86326-4123
(928) 634-4278
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
AL8288C
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
580662
AHCCCS PROVIDER NUMBER
AZ
Enumeration date
03/17/2011
Last updated
03/17/2011
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