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General NPI Number Information
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NPI Number | 1730691635
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Entity Type | Organization
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Legal Business Name | APOLLO RAL LLC
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Dates
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Enumeration Date | 11/01/2017
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Last Update Date | 11/01/2017
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Provider Practice Location Address
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Address Line | 4719 W HARMONT DR
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City | GLENDALE
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State | AZ
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Zip | 85302-6416
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Country | US
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Telephone | 623-930-6764
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Fax | 623-930-1233
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Provider Business Mailing Address
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Address Line | 8405 W DALEY LN
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City | PEORIA
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State | AZ
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Zip | 85383-2013
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Country | US
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Telephone | 801-310-3031
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. JORDAN GLENN
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Credential | DO
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Telephone | 801-310-3031
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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 | AL9918H
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License Number State | AZ
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