=====================================================
General NPI Number Information
=====================================================
NPI Number | 1861086829
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SHARON LANELLE FAUBUSH
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/21/2021
-----------------------------------------------------
Last Update Date | 02/21/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7760 S SIX SHOOTER CANYON RD
-----------------------------------------------------
City | GLOBE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85501-4078
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 928-793-4603
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1584
-----------------------------------------------------
City | GLOBE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85502-1584
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 928-961-4828
-----------------------------------------------------
Fax | 928-793-4029
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 310400000X
-----------------------------------------------------
Taxonomy Name | Assisted Living Facility
-----------------------------------------------------
License Number | AL8314H
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------