Healthcare Provider Details

I. General information

NPI: 1164576724
Provider Name (Legal Business Name): ZAHRA C. M. PLAGENS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 09/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7445 W CHERYL DR
PEORIA AZ
85345-6722
US

IV. Provider business mailing address

7445 W CHERYL DR
PEORIA AZ
85345-6722
US

V. Phone/Fax

Practice location:
  • Phone: 623-878-0463
  • Fax:
Mailing address:
  • Phone: 623-878-0463
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3104A0625X
TaxonomyAssisted Living Facility (Mental Illness)
License NumberBH2522
License Number StateAZ

VIII. Authorized Official

Name: MRS. ZAHRA CHEBET PLAGENS
Title or Position: ADMINISTRATOR
Credential:
Phone: 623-878-0463