Provider Demographics
NPI:1841764446
Name:BULLHEAD CITY SENIOR LIVING, LLC
Entity Type:Organization
Organization Name:BULLHEAD CITY SENIOR LIVING, LLC
Other - Org Name:JOSHUA SPRINGS SENIOR LIVING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:FRESHWATER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-797-4000
Mailing Address - Street 1:2020 W RUDASILL RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85704-7800
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2995 DESERT SKY BLVD
Practice Address - Street 2:
Practice Address - City:BULLHEAD CITY
Practice Address - State:AZ
Practice Address - Zip Code:86442-8855
Practice Address - Country:US
Practice Address - Phone:928-255-1519
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-16
Last Update Date:2023-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAL9873CMedicaid