Organization
SIERRA BLANCA REHABILITATION LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MATTHEW K MEYER (ADMINISTRATOR/OWNER)
(480) 652-5628
Entity
Organization
Contact information
Practice address
3401 LOCKWOOD DR, LAKESIDE, AZ 85929-5613
(928) 368-2060
(928) 368-2085
Mailing address
3401 LOCKWOOD DR, LAKESIDE, AZ 85929-5613
(928) 368-2060
(928) 368-2085
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
NCI 2691
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
035722
MEDICARE PTAN
AZ
05
—
573045
—
AZ
Enumeration date
04/24/2014
Last updated
04/24/2014
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