Healthcare Provider Details

I. General information

NPI: 1073503777
Provider Name (Legal Business Name): ARCHIE HENDRICKS SR SKILLED NURSING FACILITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2005
Last Update Date: 09/25/2024
Certification Date: 09/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HC 01 BOX 9100
SELLS AZ
85634
US

IV. Provider business mailing address

HC 01 BOX 9100
SELLS AZ
85634
US

V. Phone/Fax

Practice location:
  • Phone: 520-361-1800
  • Fax: 520-361-3656
Mailing address:
  • Phone: 520-585-5500
  • Fax: 520-585-5510

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. ROSS WILKOFF
Title or Position: ADMINISTRATOR
Credential:
Phone: 520-585-5500