Organization
HOLBROOK SENIOR CITIZENS ASSOCIATION
Active
Other names
Holbrook Senior Citizens Extended Care
Organization subpart
No
Provider details
NPI number
Authorized official
LISA SALAZAR (ADMINISTRATOR)
(928) 524-2344
Entity
Organization
Contact information
Practice address
216 JOY NEVIN AVENUE, HOLBROOK, AZ 86025
(928) 524-2344
(928) 524-3603
Mailing address
PO BOX 580, HOLBROOK, AZ 86025
(928) 524-2344
(928) 524-3603
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
AL0054C
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
829731
AHCCCS PROVIDER NUMBER
AZ
Enumeration date
12/05/2012
Last updated
12/05/2012
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