Provider Demographics
NPI:1578794442
Name:HINKSON ASSISTED LIVING CENTER
Entity Type:Organization
Organization Name:HINKSON ASSISTED LIVING CENTER
Other - Org Name:LA CASA SERENA
Other - Org Type:Other Name
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:RHONDA
Authorized Official - Middle Name:LEA
Authorized Official - Last Name:SHOCKLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MANAGER CERTIFICATIO
Authorized Official - Phone:928-337-2799
Mailing Address - Street 1:PO BOX 3570
Mailing Address - Street 2:
Mailing Address - City:SAINT JOHNS
Mailing Address - State:AZ
Mailing Address - Zip Code:85936-3570
Mailing Address - Country:US
Mailing Address - Phone:928-337-2499
Mailing Address - Fax:928-337-3501
Practice Address - Street 1:725 N.13TH W.
Practice Address - Street 2:
Practice Address - City:SAINT JOHNS
Practice Address - State:AZ
Practice Address - Zip Code:85936-3570
Practice Address - Country:US
Practice Address - Phone:928-337-2499
Practice Address - Fax:928-337-3501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-27
Last Update Date:2009-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZALC-7130310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility