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General NPI Number Information
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NPI Number | 1164970059
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Entity Type | Organization
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Legal Business Name | CORNELIA & IOAN BASA
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Dates
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Enumeration Date | 09/20/2016
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Last Update Date | 09/20/2016
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Provider Practice Location Address
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Address Line | 13330 N 88TH PL
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City | SCOTTSDALE
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State | AZ
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Zip | 85260-7633
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Country | US
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Telephone | 602-622-1667
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Fax |
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Provider Business Mailing Address
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Address Line | 13330 N 88TH PL
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City | SCOTTSDALE
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State | AZ
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Zip | 85260-7633
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Country | US
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Telephone | 602-622-1667
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Fax |
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Authorized Official
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Title or Position | BILLING SUPERVISOR
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Name | MRS. DHANA PRABHU
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Credential |
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Telephone | 602-338-9699
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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 | AL4870H
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License Number State | AZ
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