Provider Demographics
NPI:1457351967
Name:HEALTHCARE MANAGEMENT PROFESSIONAL, INC.
Entity Type:Organization
Organization Name:HEALTHCARE MANAGEMENT PROFESSIONAL, INC.
Other - Org Name:THE GARDENS REHAB & CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DEAN
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:KIDDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-718-4852
Mailing Address - Street 1:3131 WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:KINGMAN
Mailing Address - State:AZ
Mailing Address - Zip Code:86401-0951
Mailing Address - Country:US
Mailing Address - Phone:928-718-0718
Mailing Address - Fax:928-718-1177
Practice Address - Street 1:3131 WESTERN AVE
Practice Address - Street 2:
Practice Address - City:KINGMAN
Practice Address - State:AZ
Practice Address - Zip Code:86401-0951
Practice Address - Country:US
Practice Address - Phone:928-718-0718
Practice Address - Fax:928-718-1177
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-26
Last Update Date:2011-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZNCI 1979314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ44-6569Medicaid
AZ035249Medicare ID - Type Unspecified