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General NPI Number Information
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NPI Number | 1427489475
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Entity Type | Organization
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Legal Business Name | VILLA OCOTILLO ASSISTED LIVING
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Dates
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Enumeration Date | 12/02/2013
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Last Update Date | 12/02/2013
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Provider Practice Location Address
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Address Line | 3327 N CIVIC CENTER PLZ
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City | SCOTTSDALE
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State | AZ
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Zip | 85251-6404
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Country | US
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Telephone | 480-422-7111
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Fax | 480-945-2344
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Provider Business Mailing Address
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Address Line | 3327 N CIVIC CENTER PLZ
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City | SCOTTSDALE
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State | AZ
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Zip | 85251-6404
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Country | US
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Telephone | 480-422-7111
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Fax | 480-945-2344
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | CARINA STUTZMAN
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Credential |
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Telephone | 480-422-0763
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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 | AL9221C
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License Number State | AZ
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