Healthcare Provider Details

I. General information

NPI: 1346189123
Provider Name (Legal Business Name): OAKWOOD ASSISTED LIVING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2026
Last Update Date: 03/26/2026
Certification Date: 03/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4332 E REDWOOD LN
PHOENIX AZ
85048-7028
US

IV. Provider business mailing address

4332 E REDWOOD LN
PHOENIX AZ
85048-7028
US

V. Phone/Fax

Practice location:
  • Phone: 480-825-7926
  • Fax:
Mailing address:
  • Phone: 480-200-1342
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: SOPHIE WAVOMBA
Title or Position: OWNER/OPERATOR
Credential:
Phone: 480-200-1342