Organization
PHOENIX MOUNTAIN NURSING CENTER INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. C BRUCE HARKINS (ASSISTANT TREASURER CFO)
(816) 734-0533
Entity
Organization
Contact information
Practice address
13232 N TATUM BLVD, PHOENIX, AZ 85032-6459
(602) 996-5200
(602) 996-6160
Mailing address
13232 N TATUM BLVD, PHOENIX, AZ 85032
(602) 996-5200
(602) 996-6160
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
NC1326
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1298610001
DMERC
—
01
—
4307000M
CIGNA HEALTH CARR OF AZ
—
05
—
447228
—
AZ
01
—
AZ0402260
BLUE CROSS BLUE SHIELD
AZ
Enumeration date
08/24/2005
Last updated
08/22/2020
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