Provider Demographics
NPI:1376374280
Name:HIGH DESERT ASSISTED LIVING LLC
Entity type:Organization
Organization Name:HIGH DESERT ASSISTED LIVING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOANNA
Authorized Official - Middle Name:J
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-870-2862
Mailing Address - Street 1:5640 N BRONCO LN
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:86314-5855
Mailing Address - Country:US
Mailing Address - Phone:808-870-2862
Mailing Address - Fax:
Practice Address - Street 1:1220 N TAPADERO DR
Practice Address - Street 2:
Practice Address - City:DEWEY
Practice Address - State:AZ
Practice Address - Zip Code:86327-5830
Practice Address - Country:US
Practice Address - Phone:928-277-4836
Practice Address - Fax:928-237-3203
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-12
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility