Healthcare Provider Details

I. General information

NPI: 1619491123
Provider Name (Legal Business Name): ALLEGIANT HEALTHCARE OF PHOENIX LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2017
Last Update Date: 06/02/2021
Certification Date: 06/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1880 E VAN BUREN ST
PHOENIX AZ
85006-3742
US

IV. Provider business mailing address

1880 E VAN BUREN ST
PHOENIX AZ
85006-3742
US

V. Phone/Fax

Practice location:
  • Phone: 602-253-4570
  • Fax:
Mailing address:
  • Phone: 480-417-7594
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3140N1450X
TaxonomyPediatric Skilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: BRENDA CODY
Title or Position: ADMINISTRATOR
Credential:
Phone: 602-253-4570