Healthcare Provider Details

I. General information

NPI: 1255765442
Provider Name (Legal Business Name): DESERT HILLS ASSISTED LIVING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2013
Last Update Date: 08/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14228 W DESERT HILLS DR
SURPRISE AZ
85379-4900
US

IV. Provider business mailing address

14228 W DESERT HILLS DR
SURPRISE AZ
85379-4900
US

V. Phone/Fax

Practice location:
  • Phone: 623-546-7918
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License NumberAL7993H
License Number StateAZ

VIII. Authorized Official

Name: SONG YU
Title or Position: OWNER/ CAREGIVER
Credential:
Phone: 623-546-7918