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General NPI Number Information
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NPI Number | 1508331398
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Entity Type | Organization
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Legal Business Name | AZ SOOKSTER LLC
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Dates
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Enumeration Date | 10/08/2018
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Last Update Date | 10/08/2018
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Provider Practice Location Address
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Address Line | 7800 N 59TH AVE
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City | GLENDALE
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State | AZ
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Zip | 85301-7861
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Country | US
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Telephone | 509-205-5571
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 14814
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City | SCOTTSDALE
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State | AZ
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Zip | 85267-4814
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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 | MRS. INSOOK LEE LANDON
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Credential | RN
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Telephone | 509-205-5571
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 385HR2060X
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Taxonomy Name | Child Intellectual and/or Developmental Disabilities Respite Care
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number |
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License Number State |
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