Healthcare Provider Details

I. General information

NPI: 1285365114
Provider Name (Legal Business Name): SILVER HOUSE ARIZONA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2022
Last Update Date: 12/13/2022
Certification Date: 12/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14379 W EUGENE TER
SURPRISE AZ
85379-6194
US

IV. Provider business mailing address

14379 W EUGENE TER
SURPRISE AZ
85379-6194
US

V. Phone/Fax

Practice location:
  • Phone: 202-681-1274
  • Fax:
Mailing address:
  • Phone: 202-681-1274
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: ASPEN DECKER
Title or Position: PRESIDENT
Credential:
Phone: 202-681-1274