Healthcare Provider Details

I. General information

NPI: 1255050878
Provider Name (Legal Business Name): SIMON ASSISTED LIVING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2022
Last Update Date: 08/25/2022
Certification Date: 08/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2912 W GLENDALE AVE
PHOENIX AZ
85051-8433
US

IV. Provider business mailing address

2912 W GLENDALE AVE
PHOENIX AZ
85051-8433
US

V. Phone/Fax

Practice location:
  • Phone: 602-687-3155
  • Fax:
Mailing address:
  • Phone: 602-687-3155
  • 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 Code3104A0630X
TaxonomyAssisted Living Facility (Behavioral Disturbances)
License Number
License Number State

VIII. Authorized Official

Name: ALEXANDRU SIMON
Title or Position: OWNER/ CAREGIVER
Credential:
Phone: 602-687-3155