Ponderosa Pine Healthcare, INC.
Skilled Nursing Facility in Mesa, AZ. Organization (NPI-2).
NPI number1235865254
StatusActive
Last updated in NPPESAug 1, 2022
Details
- NPI
- 1235865254
- Entity type
- Organization (NPI-2)
- Legal business name
- Ponderosa Pine Healthcare, INC.
- Organization subpart
- No
- Enumeration date
- Aug 1, 2022
- Certification date
- Aug 1, 2022
- Last updated
- Aug 1, 2022
Medicare and OIG
- Medicare enrolled (PECOS)
- Not in the Medicare enrollment file
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 314000000X | Skilled Nursing Facility | – | – | Yes |
Practice location
3130 E Broadway RdMesa, AZ 85204-1740
Phone 480-924-7777 · Fax 480-924-5712
Mailing address
3130 E Broadway RdMesa, AZ 85204-1740
Phone 480-924-7777 · Fax 480-924-5712
Authorized official
Soon Burnam
Treasurer
9495401249
Is something wrong?
This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
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