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General NPI Number Information
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NPI Number | 1558753533
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Entity Type | Organization
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Legal Business Name | GOLDEN LIFE ASSISTED LIVING HOME-1
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Dates
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Enumeration Date | 02/27/2015
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Last Update Date | 02/27/2015
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Provider Practice Location Address
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Address Line | 4113 W HAYWARD AVE
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City | PHOENIX
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State | AZ
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Zip | 85051-5751
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Country | US
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Telephone | 602-332-0780
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Fax | 623-399-8915
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Provider Business Mailing Address
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Address Line | 4113 W HAYWARD AVE
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City | PHOENIX
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State | AZ
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Zip | 85051-5751
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Country | US
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Telephone | 602-332-0780
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Fax | 623-399-8915
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | REBECCA SIDDIQUI
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Credential |
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Telephone | 602-332-0780
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number | AL8880H
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License Number State | AZ
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