BOULDER GARDENS ASSISTANT LIVING LLC NPI 1114262292

NPI Information

  • NPI: 1114262292
  • Provider Name: BOULDER GARDENS ASSISTANT LIVING, LLC
  • Classification: Assisted Living Facility - 310400000X
  • Entity Type: Organization
  • Address: 860 DOUGHERTY ST
    PRESCOTT, AZ
    ZIP 86305
  • Phone: (928) 778-9667

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NPI Details

BOULDER GARDENS ASSISTANT LIVING, LLC is an assisted living facility in Prescott, 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. BOULDER GARDENS ASSISTANT LIVING, LLC NPI is 1114262292. The provider is registered as an organization entity type.

The provider's business location address is:

860 DOUGHERTY ST
PRESCOTT, AZ
ZIP 86305-841
Phone: (928) 778-9667
Fax: (520) 393-1044

The provider's authorized official is Carl Zimmerman .
The authorized official title is Senior Vice President and has the following contact phone number (520) 352-3019.

The enumeration date for this NPI number is 11/30/2012 and was last updated on 11/30/2012.

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 FacilityAL1494CARIZONAYes

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
1AL1494COTHERARIZONASTATE LICENSE

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: 11/21/2025

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