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General NPI Number Information
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NPI Number | 1962874354
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Entity Type | Organization
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Legal Business Name | APOLLO RESIDENTIAL ASSISTED LIVING, LLC
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Dates
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Enumeration Date | 10/23/2015
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Last Update Date | 10/23/2015
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Provider Practice Location Address
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Address Line | 4719 W HARMONT DR
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City | GLENDALE
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State | AZ
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Zip | 85302-6416
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Country | US
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Telephone | 623-238-2285
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Fax |
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Provider Business Mailing Address
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Address Line | 14202 W MAUNA LOA LN
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City | SURPRISE
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State | AZ
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Zip | 85379-8669
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Country | US
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Telephone | 623-238-2285
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Fax |
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Authorized Official
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Title or Position | OWNER/MEMBER
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Name | STEPHANIE JENKINS
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Credential | RN
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Telephone | 623-238-2285
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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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