Healthcare Provider Details

I. General information

NPI: 1922326693
Provider Name (Legal Business Name): MEMORY CARE OF ARIZONA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2010
Last Update Date: 05/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21061 E STIRRUP ST
QUEEN CREEK AZ
85142-6523
US

IV. Provider business mailing address

21061 E STIRRUP ST
QUEEN CREEK AZ
85142-6523
US

V. Phone/Fax

Practice location:
  • Phone: 480-730-8502
  • Fax:
Mailing address:
  • Phone: 480-730-8502
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2472E0500X
TaxonomyEEG Technician
License Number
License Number State

VIII. Authorized Official

Name: MS. CORA MARIE FLORER
Title or Position: CEO
Credential:
Phone: 602-402-8171