Provider Demographics
NPI:1023441862
Name:MINGUS MOUNTAIN ESTATE RESIDENTIAL CENTER INC
Entity type:Organization
Organization Name:MINGUS MOUNTAIN ESTATE RESIDENTIAL CENTER INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MCFARLAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-335-2000
Mailing Address - Street 1:PO BOX 26485
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:86312-6485
Mailing Address - Country:US
Mailing Address - Phone:602-335-2000
Mailing Address - Fax:602-476-1910
Practice Address - Street 1:2430 W WHITE FEATHER LN
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85085-4794
Practice Address - Country:US
Practice Address - Phone:623-780-4882
Practice Address - Fax:602-476-1910
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-15
Last Update Date:2013-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBH43273104A0630X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0630XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Behavioral Disturbances