Provider Demographics
NPI:1588838874
Name:SOLTERRA AT WHITE MOUNTAINS, LLC
Entity Type:Organization
Organization Name:SOLTERRA AT WHITE MOUNTAINS, LLC
Other - Org Name:SOLTERRA AT WHITE MOUNTAINS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ANITA
Authorized Official - Middle Name:
Authorized Official - Last Name:JAMES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-532-4600
Mailing Address - Street 1:5408 ARIZONA HIGHWAY 260
Mailing Address - Street 2:
Mailing Address - City:LAKESIDE
Mailing Address - State:AZ
Mailing Address - Zip Code:85929
Mailing Address - Country:US
Mailing Address - Phone:928-532-4600
Mailing Address - Fax:
Practice Address - Street 1:5408 ARIZONA HIGHWAY 260
Practice Address - Street 2:
Practice Address - City:LAKESIDE
Practice Address - State:AZ
Practice Address - Zip Code:85929
Practice Address - Country:US
Practice Address - Phone:928-532-4600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-17
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZALC6571310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAPPLIED FORMedicaid