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General NPI Number Information
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NPI Number | 1407129950
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Entity Type | Organization
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Legal Business Name | JR NENG HERNANDEZ ASSISTED LIVING
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Dates
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Enumeration Date | 02/14/2012
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Last Update Date | 08/06/2012
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Provider Practice Location Address
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Address Line | 11528 W MADERO DR
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City | ARIZONA CITY
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State | AZ
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Zip | 85123
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Country | US
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Telephone | 520-582-4978
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 3077
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City | ARIZONA CITY
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State | AZ
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Zip | 85123-0857
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Country | US
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Telephone | 520-582-4978
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. ENCARNACION ESPINOZA HERNANDEZ JR.
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Credential |
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Telephone | 520-582-4978
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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 | AZ
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