Organization
PONDEROSA ASSISTED LIVING
Active
Organization
PONDEROSA ASSISTED LIVING
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LISA E KENNEDY (OWNER/MANAGER)
(928) 635-4179
Entity
Organization
Contact information
Practice address
826 HEREFORD DR, WILLIAMS, AZ 86046-9789
(928) 635-4179
Mailing address
PO BOX 16153, BELLEMONT, AZ 86015-6153
(928) 635-4199
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
—
AZ
Other
Enumeration date
12/15/2008
Last updated
12/15/2008
Update your record
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