Provider Demographics
NPI:1932148475
Name:LA POSADA AT PARK CENTRE INC
Entity Type:Organization
Organization Name:LA POSADA AT PARK CENTRE INC
Other - Org Name:LA POSADA OUTPATIENT THERAPIES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:KOLNACKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-648-8380
Mailing Address - Street 1:700 S LA POSADA CIR
Mailing Address - Street 2:
Mailing Address - City:GREEN VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85614-5100
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:700 S LA POSADA CIR
Practice Address - Street 2:
Practice Address - City:GREEN VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85614-5100
Practice Address - Country:US
Practice Address - Phone:520-648-2200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-06
Last Update Date:2014-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZOTC 0533261QR0400X
AZNCI402314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ150057Medicare PIN
AZ036543Medicare Oscar/Certification