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General NPI Number Information
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NPI Number | 1154880748
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Entity Type | Organization
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Legal Business Name | ST WALTER LLC
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Dates
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Enumeration Date | 03/14/2019
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Last Update Date | 03/14/2019
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Provider Practice Location Address
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Address Line | 8650 S LOS FELIZ DR
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City | TEMPE
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State | AZ
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Zip | 85284-2583
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Country | US
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Telephone | 480-730-9110
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Fax | 480-775-7713
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Provider Business Mailing Address
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Address Line | 840 E CANYON WAY
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City | CHANDLER
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State | AZ
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Zip | 85249-5348
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Country | US
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Telephone | 480-326-5143
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Fax | 480-775-7713
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Authorized Official
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Title or Position | CEO
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Name | ANNA MANALO
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Credential | FNP-C
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Telephone | 480-326-5143
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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 |
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License Number State |
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