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General NPI Number Information
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NPI Number | 1538563143
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Entity Type | Organization
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Legal Business Name | ABOUT SENIORS ASSISTED LIVING HOME, LLC
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Dates
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Enumeration Date | 10/11/2014
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Last Update Date | 10/11/2014
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Provider Practice Location Address
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Address Line | 17343 W BAJADA DR
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City | SURPRISE
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State | AZ
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Zip | 85387-1002
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Country | US
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Telephone | 602-339-3617
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Fax |
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Provider Business Mailing Address
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Address Line | 17343 W BAJADA DR
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City | SURPRISE
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State | AZ
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Zip | 85387-1002
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Country | US
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Telephone | 602-339-3617
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Fax |
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Authorized Official
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Title or Position | MANAGER/MEMBER
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Name | DENISA KAPORALIS
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Credential |
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Telephone | 602-339-3617
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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 | AL 9389
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License Number State | AZ
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