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General NPI Number Information
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NPI Number | 1760671986
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Entity Type | Organization
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Legal Business Name | HIDDEN GARDEN ASSISTED LIVING, LLC
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Dates
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Enumeration Date | 10/24/2007
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Last Update Date | 10/24/2007
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Provider Practice Location Address
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Address Line | 5005 CORTE VIS
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City | SIERRA VISTA
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State | AZ
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Zip | 85635-7111
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Country | US
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Telephone | 520-515-0394
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Fax | 520-458-9314
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Provider Business Mailing Address
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Address Line | 5005 CORTE VIS
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City | SIERRA VISTA
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State | AZ
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Zip | 85635-7111
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Country | US
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Telephone | 520-515-0394
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Fax | 520-458-9314
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Authorized Official
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Title or Position | OWNER
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Name | MR. DANIEL C PARROTTA
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Credential |
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Telephone | 520-515-0394
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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 | ALH-6413
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License Number State | AZ
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