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General NPI Number Information
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NPI Number | 1225553985
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Entity Type | Organization
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Legal Business Name | ELMER PLACE FOR PARENTS
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Dates
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Enumeration Date | 08/03/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 25968 N.SANDSTONE WAY
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City | SURPRISE
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State | AZ
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Zip | 85387
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Country | US
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Telephone | 623-337-4753
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Fax | 623-374-6187
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Provider Business Mailing Address
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Address Line | 25968 N SANDSTONE WAY
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City | SURPRISE
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State | AZ
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Zip | 85387-6837
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Country | US
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Telephone | 623-337-4753
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Fax | 623-374-6187
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Authorized Official
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Title or Position | OWNER
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Name | MR. ELMER NABONG DELA CRUZ
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Credential |
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Telephone | 623-337-4753
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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 | AL10437H
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License Number State | AZ
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