Healthcare Provider Details

I. General information

NPI: 1497808034
Provider Name (Legal Business Name): SHOLT CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

660 N BECK AVE
CHANDLER AZ
85226-1744
US

IV. Provider business mailing address

660 N BECK AVE
CHANDLER AZ
85226-1744
US

V. Phone/Fax

Practice location:
  • Phone: 480-705-9124
  • Fax: 480-522-1919
Mailing address:
  • Phone: 480-705-9124
  • Fax: 480-522-1919

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3104A0630X
TaxonomyAssisted Living Facility (Behavioral Disturbances)
License NumberALH5217
License Number StateAZ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier946626
Identifier TypeMEDICAID
Identifier StateAZ
Identifier Issuer

VIII. Authorized Official

Name: MS. SANDRA H. HOLT
Title or Position: PRESIDENT & CEO
Credential: BS, MS, LPC
Phone: 480-705-9124