Provider Demographics
NPI:1982769907
Name:CERBAT GUEST HOME INC.
Entity Type:Organization
Organization Name:CERBAT GUEST HOME INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY,OWNER,MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:DARLENE
Authorized Official - Last Name:SCHMITZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-753-3731
Mailing Address - Street 1:2364 E CARVER AVE
Mailing Address - Street 2:
Mailing Address - City:KINGMAN
Mailing Address - State:AZ
Mailing Address - Zip Code:86409-1224
Mailing Address - Country:US
Mailing Address - Phone:928-757-3989
Mailing Address - Fax:
Practice Address - Street 1:2364 E CARVER AVE
Practice Address - Street 2:
Practice Address - City:KINGMAN
Practice Address - State:AZ
Practice Address - Zip Code:86409-1224
Practice Address - Country:US
Practice Address - Phone:928-757-3989
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZALC-2600311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZALC-2600OtherFACILITY LICENCE