Healthcare Provider Details

I. General information

NPI: 1699685636
Provider Name (Legal Business Name): AD3 MALONE SENIOR HOME LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

819 W SAN MIGUEL AVE
PHOENIX AZ
85013-1744
US

IV. Provider business mailing address

819 W SAN MIGUEL AVE
PHOENIX AZ
85013-1744
US

V. Phone/Fax

Practice location:
  • Phone: 773-992-7554
  • Fax: 480-306-8850
Mailing address:
  • Phone: 773-992-7554
  • Fax: 480-306-8850

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: MR. DARRYL LUVEN MALONE
Title or Position: OWNER
Credential:
Phone: 773-992-7554