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General NPI Number Information
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NPI Number | 1164014197
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Entity Type | Organization
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Legal Business Name | ARIZONA SENIOR LIFE LLC
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Dates
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Enumeration Date | 02/10/2021
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Last Update Date | 02/10/2021
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Provider Practice Location Address
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Address Line | 2134 E PALM LN
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City | PHOENIX
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State | AZ
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Zip | 85006-2405
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Country | US
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Telephone | 602-275-5955
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Fax | 480-659-3825
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Provider Business Mailing Address
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Address Line | 2105 W WEATHERBY WAY
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City | CHANDLER
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State | AZ
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Zip | 85286-8443
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Country | US
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Telephone | 605-310-1940
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Fax | 480-659-3825
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Authorized Official
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Title or Position | OWNER
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Name | LEA TALLO
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Credential |
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Telephone | 605-310-1940
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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