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General NPI Number Information
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NPI Number | 1275052151
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Entity Type | Organization
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Legal Business Name | ARROWHEAD SHORE SENIOR LIVING, LLC
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Dates
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Enumeration Date | 09/12/2017
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Last Update Date | 09/12/2017
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Provider Practice Location Address
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Address Line | 16124 N 87TH DR
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City | PEORIA
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State | AZ
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Zip | 85382-3771
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Country | US
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Telephone | 602-818-2310
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Fax |
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Provider Business Mailing Address
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Address Line | 7874 W CALAVAR RD
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City | PEORIA
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State | AZ
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Zip | 85381-4669
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. ELIZABETH DIEDRICH
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Credential |
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Telephone | 602-818-2310
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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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