Healthcare Provider Details

I. General information

NPI: 1770026635
Provider Name (Legal Business Name): SDANCEL MANAGEMENT SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2016
Last Update Date: 11/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15724 N 168TH LN
SURPRISE AZ
85388-1349
US

IV. Provider business mailing address

15724 N 168TH LN
SURPRISE AZ
85388-1349
US

V. Phone/Fax

Practice location:
  • Phone: 623-755-5359
  • Fax: 623-322-1968
Mailing address:
  • Phone: 623-755-5359
  • Fax: 623-322-1968

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License NumberAL9154H
License Number StateAZ

VIII. Authorized Official

Name: MR. SANTOS CAINTIC DANCEL
Title or Position: OWNER
Credential:
Phone: 623-755-5359