Organization
MINGUS MOUNTAIN ESTATE RESIDENTIAL CENTER INC
Active
Other names
Emily House
Organization subpart
No
Provider details
NPI number
Authorized official
BROOKE WILSON (SENIOR CREDENTIALING SPECIALIST)
(602) 335-2000
Entity
Organization
Contact information
Practice address
3801 N ROBERT RD, PRESCOTT VALLEY, AZ 86314-8107
(602) 335-2095
(602) 249-1311
Mailing address
2517 N GREAT WESTERN DR, PRESCOTT VALLEY, AZ 86314-2597
(602) 335-2000
(480) 534-7494
Taxonomy
Speciality
Code
Description
License number
State
3104A0630X
Assisted Living Facility (Behavioral Disturbances)
Primary
BH-1487
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
498057
—
AZ
Enumeration date
11/16/2006
Last updated
03/10/2025
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