Healthcare Provider Details

I. General information

NPI: 1982763751
Provider Name (Legal Business Name): CHANDLER ADULT CARE HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1781 E FOLLEY CT
CHANDLER AZ
85225-2274
US

IV. Provider business mailing address

1781 E FOLLEY CT
CHANDLER AZ
85225-2274
US

V. Phone/Fax

Practice location:
  • Phone: 480-786-6008
  • Fax: 480-659-6158
Mailing address:
  • Phone: 480-786-6008
  • Fax: 480-659-6158

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number1511
License Number StateAZ

VIII. Authorized Official

Name: MRS. ADELINA PANGANIBAN SOMERA
Title or Position: ADMINISTRATOR, MANAGER
Credential:
Phone: 480-786-6008