MEDICARE: DAYLIGHT ASSISTED LIVING FACILITY LLC

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	310400000X	Assisted Living Facility

General Provider Information

NPI Number	:	1740036037
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DAYLIGHT ASSISTED LIVING FACILITY LLC

Provider Business Mailing Address
First Line	:	1345 W ATLANTA AVE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85041-3929
Country	:	US
Telephone Number	:	951-250-1242
Fax Number	:	602-314-7975

Provider Business Practice Location Address
First Line	:	1345 W ATLANTA AVE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85041-3929
Country	:	US
Telephone Number	:	951-250-1242
Fax Number	:	602-314-7975

Authorized Official
Title or Position	:	MANAGER/ OWNER
Name	:	BRICEIDA ROCHA
Credential	:
Telephone Number	:	951-250-1242

Provider Enumeration Date	:	04/26/2024
Last Update Date	:	04/26/2024

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