Organization
PONDEROSA SENIOR ASSISTED LIVING, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LISA E KENNEDY (OWNER)
(928) 213-1187
Entity
Organization
Contact information
Practice address
4490 N BELLEMONT SPRINGS, BELLEMONT, AZ 86015
(928) 213-1187
Mailing address
PO BOX 16193, BELLEMONT, AZ 86015
(928) 213-1187
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
ALH6417
ASSISTED LIVING
AZ
Enumeration date
12/27/2007
Last updated
12/27/2007
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