Healthcare Provider Details

I. General information

NPI: 1205977261
Provider Name (Legal Business Name): CORNWALL HEALTH SYSTEMS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/10/2007
Last Update Date: 09/28/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4229 N 82ND AVE
PHOENIX AZ
85033-2332
US

IV. Provider business mailing address

4229 N 82ND AVE
PHOENIX AZ
85033-2332
US

V. Phone/Fax

Practice location:
  • Phone: 623-845-0774
  • Fax: 623-974-8322
Mailing address:
  • Phone: 623-845-0774
  • Fax: 623-974-8322

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License NumberALH5269
License Number StateAZ

VIII. Authorized Official

Name: MS. LORNA OPHELIA CALLENDER
Title or Position: ADMINISTRATOR MANAGER
Credential: R.N.
Phone: 623-845-0774