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General NPI Number Information
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NPI Number | 1184150484
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Entity Type | Organization
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Legal Business Name | NDG ADULT CARE HOME LLC
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Dates
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Enumeration Date | 05/04/2017
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Last Update Date | 05/04/2017
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Provider Practice Location Address
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Address Line | 1106 W 9TH ST
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City | TEMPE
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State | AZ
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Zip | 85281-5304
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Country | US
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Telephone | 480-894-2902
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Fax |
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Provider Business Mailing Address
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Address Line | 1106 W 9TH ST
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City | TEMPE
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State | AZ
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Zip | 85281-5304
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Country | US
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Telephone | 480-894-2902
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Fax |
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Authorized Official
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Title or Position | LICENSEE
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Name | NELLIE GALIT
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Credential |
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Telephone | 480-894-2902
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320700000X
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Taxonomy Name | Physical Disabilities Residential Treatment Facility
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License Number | AL7288H
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License Number State | AZ
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