Healthcare Provider Details

I. General information

NPI: 1083474704
Provider Name (Legal Business Name): SODALITY ASSISTED LIVING , LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2024
Last Update Date: 03/29/2024
Certification Date: 03/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8846 N 30TH AVE
PHOENIX AZ
85051-3919
US

IV. Provider business mailing address

8846 N 30TH AVE
PHOENIX AZ
85051-3919
US

V. Phone/Fax

Practice location:
  • Phone: 152-070-9464
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code315D00000X
TaxonomyInpatient Hospice
License Number
License Number State

VIII. Authorized Official

Name: MR. DENTON DIAS
Title or Position: OWNER
Credential:
Phone: 520-217-0368