Provider Demographics
NPI:1134125750
Name:INFINIA AT CAMP VERDE
Entity Type:Organization
Organization Name:INFINIA AT CAMP VERDE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBERTSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-295-8000
Mailing Address - Street 1:15 E HIGHWAY 260
Mailing Address - Street 2:
Mailing Address - City:CAMP VERDE
Mailing Address - State:AZ
Mailing Address - Zip Code:86322-6864
Mailing Address - Country:US
Mailing Address - Phone:928-567-5253
Mailing Address - Fax:928-567-3794
Practice Address - Street 1:15 E HIGHWAY 260
Practice Address - Street 2:
Practice Address - City:CAMP VERDE
Practice Address - State:AZ
Practice Address - Zip Code:86322-6864
Practice Address - Country:US
Practice Address - Phone:928-567-5253
Practice Address - Fax:928-567-3794
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZNCI-366314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ707375Medicaid
AZ707375Medicaid