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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