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General NPI Number Information
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NPI Number | 1902400500
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Entity Type | Organization
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Legal Business Name | STERLING-S HAVEN
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Dates
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Enumeration Date | 11/24/2020
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Last Update Date | 11/24/2020
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Provider Practice Location Address
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Address Line | 4715 S 99TH DR
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City | TOLLESON
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State | AZ
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Zip | 85353-4450
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Country | US
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Telephone | 623-205-7196
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Fax |
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Provider Business Mailing Address
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Address Line | 4715 S 99TH DR
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City | TOLLESON
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State | AZ
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Zip | 85353-4450
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Country | US
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Telephone | 623-205-7196
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. ROSALYN GRAHAM
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Credential | LPN
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Telephone | 623-205-7196
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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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