Healthcare Provider Details

I. General information

NPI: 1730395757
Provider Name (Legal Business Name): DARIENNE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 06/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2150 S 1ST AVE
SAFFORD AZ
85546-2204
US

IV. Provider business mailing address

2150 S 1ST AVE
SAFFORD AZ
85546-2204
US

V. Phone/Fax

Practice location:
  • Phone: 928-348-3293
  • Fax:
Mailing address:
  • Phone: 928-348-3293
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License NumberADH6049
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1710
License Number StateAZ

VIII. Authorized Official

Name: LA WYNN BROWN
Title or Position: OWNER
Credential: PT
Phone: 928-428-0280