MEDICARE: ARCHIE HENDRICKS SR SKILLED NURSING FACILITY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1073503777
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ARCHIE HENDRICKS SR SKILLED NURSING FACILITY

Provider Business Mailing Address
First Line	:	HC 01 BOX 9100
Second Line	:
City	:	SELLS
State	:	AZ
Zip	:	85634
Country	:	US
Telephone Number	:	520-585-5500
Fax Number	:	520-585-5510

Provider Business Practice Location Address
First Line	:	HC 01 BOX 9100
Second Line	:
City	:	SELLS
State	:	AZ
Zip	:	85634
Country	:	US
Telephone Number	:	520-361-1800
Fax Number	:	520-361-3656

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MR. ROSS WILKOFF
Credential	:
Telephone Number	:	520-585-5500

Provider Enumeration Date	:	10/24/2005
Last Update Date	:	09/25/2024

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