Healthcare Provider Details

I. General information

NPI: 1205824653
Provider Name (Legal Business Name): ARIZONA EASTERN STAR RETIREMENT CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4602 N 24TH ST
PHOENIX AZ
85016-5253
US

IV. Provider business mailing address

4602 N 24TH ST
PHOENIX AZ
85016-5253
US

V. Phone/Fax

Practice location:
  • Phone: 602-833-8344
  • Fax:
Mailing address:
  • Phone:
  • Fax: 602-553-8344

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License NumberALC-4559
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberNCI-307
License Number StateAZ

VIII. Authorized Official

Name: MARIA PARHAM
Title or Position: ADMINISTRATOR
Credential:
Phone: 602-954-9178