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General NPI Number Information
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NPI Number | 1962653535
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Entity Type | Organization
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Legal Business Name | ARCHIE HENDRICKS SR SKILLED NURSING FACILITY
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Dates
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Enumeration Date | 10/01/2008
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Last Update Date | 09/27/2024
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Provider Practice Location Address
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Address Line | MILEPOST 9 FEDERAL ROUTE 15
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City | SELLS
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State | AZ
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Zip | 85634-9744
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Country | US
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Telephone | 520-585-5500
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Fax | 520-585-5510
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Provider Business Mailing Address
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Address Line | HC01 BOX 9100
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City | SELLS
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State | AZ
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Zip | 85634-9744
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Country | US
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Telephone | 520-585-5500
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Fax | 520-585-5510
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. ROSS WILKOFF
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Credential |
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Telephone | 520-585-5500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251G00000X
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Taxonomy Name | Community Based Hospice Care Agency
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License Number |
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License Number State |
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