Provider Demographics
NPI:1386010759
Name:IRONWOOD ASSISTED LIVING HOME, LLC
Entity Type:Organization
Organization Name:IRONWOOD ASSISTED LIVING HOME, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:ALMA
Authorized Official - Middle Name:LABUAN
Authorized Official - Last Name:HENNINGSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-474-2111
Mailing Address - Street 1:1226 W 13TH AVE
Mailing Address - Street 2:
Mailing Address - City:APACHE JUNCTION
Mailing Address - State:AZ
Mailing Address - Zip Code:85120-6269
Mailing Address - Country:US
Mailing Address - Phone:480-474-2111
Mailing Address - Fax:
Practice Address - Street 1:1226 W 13TH AVE
Practice Address - Street 2:
Practice Address - City:APACHE JUNCTION
Practice Address - State:AZ
Practice Address - Zip Code:85120-6269
Practice Address - Country:US
Practice Address - Phone:480-474-2111
Practice Address - Fax:480-474-2111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-19
Last Update Date:2015-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAL9190H310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility