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General NPI Number Information
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NPI Number | 1801548474
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Entity Type | Organization
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Legal Business Name | HOLLYHOCK ASSISTED LIVING LLC
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Dates
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Enumeration Date | 01/25/2022
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Last Update Date | 01/25/2022
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Provider Practice Location Address
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Address Line | 16552 N HOLLYHOCK ST
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City | SURPRISE
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State | AZ
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Zip | 85378-3667
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Country | US
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Telephone | 160-233-2078
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Fax |
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Provider Business Mailing Address
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Address Line | 16552 N HOLLYHOCK ST
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City | SURPRISE
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State | AZ
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Zip | 85378-3667
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Country | US
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Telephone | 160-233-2078
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Fax |
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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 | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State |
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