Provider Demographics
NPI:1255860763
Name:WELBROOK SENIOR LIVING FLAGSTAFF LLC
Entity Type:Organization
Organization Name:WELBROOK SENIOR LIVING FLAGSTAFF LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MATT
Authorized Official - Middle Name:
Authorized Official - Last Name:RASBAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-683-6565
Mailing Address - Street 1:450 S 400 E STE 200
Mailing Address - Street 2:
Mailing Address - City:BOUNTIFUL
Mailing Address - State:UT
Mailing Address - Zip Code:84010-5094
Mailing Address - Country:US
Mailing Address - Phone:801-683-6565
Mailing Address - Fax:
Practice Address - Street 1:1521 N PINE CLIFF DR
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001
Practice Address - Country:US
Practice Address - Phone:801-683-6565
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-08
Last Update Date:2018-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility