Healthcare Provider Details

I. General information

NPI: 1437512084
Provider Name (Legal Business Name): DIGNITY LIVING CENTERS OF NORTH AMERICA PALO VERDE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2016
Last Update Date: 03/31/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4614 W PALO VERDE DR
GLENDALE AZ
85301-6249
US

IV. Provider business mailing address

4614 W PALO VERDE DR
GLENDALE AZ
85301-6249
US

V. Phone/Fax

Practice location:
  • Phone: 623-934-0094
  • Fax: 480-247-5288
Mailing address:
  • Phone: 623-934-0094
  • Fax: 480-247-5288

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberRN153739
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberRN153739
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN153739
License Number StateAZ
# 4
Primary TaxonomyN
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License NumberRN153739
License Number StateAZ
# 5
Primary TaxonomyN
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License NumberRN153739
License Number StateAZ
# 6
Primary TaxonomyN
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License NumberRN153739
License Number StateAZ
# 7
Primary TaxonomyN
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License NumberRN153739
License Number StateAZ
# 8
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberRN153739
License Number StateAZ
# 9
Primary TaxonomyN
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License NumberRN153739
License Number StateAZ
# 10
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License NumberRN153739
License Number StateAZ
# 11
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License NumberRN153739
License Number StateAZ
# 12
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License NumberRN153739
License Number StateAZ

VIII. Authorized Official

Name: JULIE ANNA HENDERSHOTT
Title or Position: CLINICAL DIRECTOR
Credential: RN
Phone: 480-524-3422