Healthcare Provider Details

I. General information

NPI: 1891142840
Provider Name (Legal Business Name): SUNTREE CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2016
Last Update Date: 05/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4120 N 20TH ST STE H
PHOENIX AZ
85016-6022
US

IV. Provider business mailing address

4120 N 20TH ST STE H
PHOENIX AZ
85016-6022
US

V. Phone/Fax

Practice location:
  • Phone: 602-575-7839
  • Fax:
Mailing address:
  • Phone: 602-575-7839
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: VAN HONG NGUYEN
Title or Position: DIRECTOR
Credential:
Phone: 602-575-7839