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General NPI Number Information
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NPI Number | 1427748094
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Entity Type | Organization
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Legal Business Name | GARDEN ENCLAVE ASSISTED LIVING HOME
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Dates
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Enumeration Date | 05/08/2023
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Last Update Date | 05/08/2023
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Provider Practice Location Address
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Address Line | 22835 E PUMMELOS RD
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City | QUEEN CREEK
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State | AZ
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Zip | 85142-2216
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Country | US
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Telephone | 602-500-1460
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Fax | 480-597-6065
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Provider Business Mailing Address
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Address Line | 22835 E PUMMELOS RD
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City | QUEEN CREEK
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State | AZ
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Zip | 85142-2216
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Country | US
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Telephone | 602-500-1460
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Fax | 480-597-6065
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Authorized Official
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Title or Position | FACILITY MANAGER
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Name | MR. ROBERT NANA ANSAH
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Credential | LPN
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Telephone | 602-500-1460
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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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