Provider Demographics
NPI:1205570595
Name:ELDER'S RANCH BY CARLA, LLC
Entity type:Organization
Organization Name:ELDER'S RANCH BY CARLA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTED LIVING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CARLA
Authorized Official - Middle Name:
Authorized Official - Last Name:LOCKHART
Authorized Official - Suffix:
Authorized Official - Credentials:NURSE PRACTITIONER
Authorized Official - Phone:602-686-0051
Mailing Address - Street 1:18163 W PUEBLO AVE
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85338-2042
Mailing Address - Country:US
Mailing Address - Phone:602-686-0051
Mailing Address - Fax:
Practice Address - Street 1:16802 N 43RD ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-3324
Practice Address - Country:US
Practice Address - Phone:602-404-4330
Practice Address - Fax:602-494-5209
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-24
Last Update Date:2022-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility