Healthcare Provider Details

I. General information

NPI: 1073704599
Provider Name (Legal Business Name): PALMS SENIOR LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2007
Last Update Date: 08/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

152 N 56TH ST
MESA AZ
85205-8718
US

IV. Provider business mailing address

152 N 56TH ST
MESA AZ
85205-8718
US

V. Phone/Fax

Practice location:
  • Phone: 480-985-0680
  • Fax: 480-396-6231
Mailing address:
  • Phone: 480-985-0680
  • Fax: 480-396-6231

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License NumberALC6182
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code311500000X
TaxonomyAlzheimer Center (Dementia Center)
License NumberALC6182
License Number StateAZ

VIII. Authorized Official

Name: MR. ROBERT THOMAS BARTEL
Title or Position: DIRECTOR
Credential:
Phone: 480-985-0680