Provider Demographics
NPI:1861854267
Name:JOSHUA SPRINGS OPERATIONS LLC
Entity Type:Organization
Organization Name:JOSHUA SPRINGS OPERATIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:ZIEBART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-882-4500
Mailing Address - Street 1:1900 HINES ST SE
Mailing Address - Street 2:STE 190
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-1337
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
Practice Address - Country:US
Practice Address - Phone:928-763-1212
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-24
Last Update Date:2016-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAL9873C302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization