Healthcare Provider Details

I. General information

NPI: 1558045252
Provider Name (Legal Business Name): SGM HEALTHCARE SERVICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2023
Last Update Date: 06/13/2023
Certification Date: 06/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3637 E PARKVIEW DR
GILBERT AZ
85295-3699
US

IV. Provider business mailing address

3637 E PARKVIEW DR
GILBERT AZ
85295-3699
US

V. Phone/Fax

Practice location:
  • Phone: 480-570-2593
  • Fax:
Mailing address:
  • Phone: 480-570-2593
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

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

VIII. Authorized Official

Name: MRS. JACQUELINE C ASANTE
Title or Position: ADMINISTRATOR
Credential:
Phone: 480-570-9259