=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952277709
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | STEFAN'S ASSISTED LIVING
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/16/2025
-----------------------------------------------------
Last Update Date | 10/16/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 16192 N 159TH AVE
-----------------------------------------------------
City | SURPRISE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85374-5813
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 623-440-2867
-----------------------------------------------------
Fax | 623-440-4132
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 16192 N 159TH AVE
-----------------------------------------------------
City | SURPRISE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85374-5813
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 623-440-2867
-----------------------------------------------------
Fax | 623-440-4132
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/MANAGER
-----------------------------------------------------
Name | STEFAN BALA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 714-240-5509
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 310400000X
-----------------------------------------------------
Taxonomy Name | Assisted Living Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------