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General NPI Number Information
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NPI Number | 1023512753
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Entity Type | Organization
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Legal Business Name | SURPRISE MEMORY CARE, LP
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Dates
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Enumeration Date | 03/19/2018
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Last Update Date | 03/19/2018
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Provider Practice Location Address
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Address Line | 16465 N PARKVIEW PL
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City | SURPRISE
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State | AZ
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Zip | 85374-7494
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Country | US
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Telephone | 623-266-4999
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Fax | 623-251-5022
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Provider Business Mailing Address
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Address Line | 16465 N PARKVIEW PL
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City | SURPRISE
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State | AZ
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Zip | 85374-7494
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Country | US
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Telephone | 623-266-4999
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Fax | 623-251-5022
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | DAWN ROMAYO
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Credential | CDP
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Telephone | 623-266-4999
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | AL9995C
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License Number State | AZ
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