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LAKE HAVASU TOO LLC NPI 1790812436


NPI Information

NPI: 1790812436
Provider Name: LAKE HAVASU TOO, LLC

Doing Business As: PRESTIGE ASSISTED LIVING AT CLAREMONT

Classification: Assisted Living Facility - 310400000X
Entity Type: Organization
Address:
1221 CLAREMONT DR
LAKE HAVASU CITY, AZ
ZIP 86406
Phone: (928) 855-4843
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LAKE HAVASU TOO, LLC is an assisted living facility in Lake Havasu City, AZ. The provider is a facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being. LAKE HAVASU TOO, LLC NPI is 1790812436. The provider is registered as an organization entity type.
The provider Is Doing Business As Prestige Assisted Living At Claremont.

The provider's business location address is:

1221 CLAREMONT DR
LAKE HAVASU CITY, AZ
ZIP 86406-684
Phone: (928) 855-4843
Fax: (928) 855-2987

The provider's authorized official is Gregory J Vislocky .
The authorized official title is Managing Member and has the following contact phone number (360) 735-7155.

The enumeration date for this NPI number is 2/28/2007 and was last updated on 8/22/2020.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1310400000XAssisted Living FacilityALC 4959ARIZONAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
121159MEDICAIDARIZONA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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