Organization
PONDEROSA PINES CARE AND REHAB, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. WILLIAM SCOTT THOMAS (SYSTEMS ADMINISTRATOR)
(801) 296-5106
Entity
Organization
Contact information
Practice address
800 W UNIVERSITY AVE, FLAGSTAFF, AZ 86001-7103
(928) 779-6931
(928) 779-2180
Mailing address
800 W UNIVERSITY AVE, FLAGSTAFF, AZ 86001-7103
(928) 779-6931
(928) 779-2180
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
NCI-340
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
707341
—
AZ
Enumeration date
02/11/2009
Last updated
02/11/2009
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