Healthcare Provider Details

I. General information

NPI: 1679739171
Provider Name (Legal Business Name): SACRED HEART HOMES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2008
Last Update Date: 08/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3828 N 36TH ST
PHOENIX AZ
85018-5106
US

IV. Provider business mailing address

3418 E INDIAN SCHOOL RD
PHOENIX AZ
85018-5113
US

V. Phone/Fax

Practice location:
  • Phone: 602-515-0783
  • Fax: 602-224-1357
Mailing address:
  • Phone: 602-277-8721
  • Fax: 602-224-1357

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License NumberALH-6720
License Number StateAZ

VIII. Authorized Official

Name: MRS. ANDREA G. DATINGALING-PANALIGAN
Title or Position: B.S.N., R.N.
Credential:
Phone: 602-277-8721