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General NPI Number Information
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NPI Number | 1891154043
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Entity Type | Organization
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Legal Business Name | SACRED HEART LLC
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Dates
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Enumeration Date | 02/16/2016
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Last Update Date | 02/16/2016
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Provider Practice Location Address
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Address Line | 13844 N 150TH DR
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City | SURPRISE
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State | AZ
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Zip | 85379-6020
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Country | US
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Telephone | 520-788-2233
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Fax | 623-444-8435
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Provider Business Mailing Address
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Address Line | 13844 N 150TH DR
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City | SURPRISE
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State | AZ
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Zip | 85379-6020
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Country | US
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Telephone | 520-788-2233
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Fax | 623-444-8435
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Authorized Official
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Title or Position | OWNER
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Name | JOHANNA SALUMBIDES
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Credential |
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Telephone | 520-788-2233
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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 | AL9707H
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License Number State | AZ
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