MEDICARE: CHAPARRAL WINDS ASSISTED LIVING

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	ALC-4190	AZ

General Provider Information

NPI Number	:	1942410253
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHAPARRAL WINDS ASSISTED LIVING

Provider Business Mailing Address
First Line	:	16623 N WEST POINT PKWY
Second Line	:
City	:	SURPRISE
State	:	AZ
Zip	:	85374-6011
Country	:	US
Telephone Number	:	623-975-0880
Fax Number	:	623-975-6031

Provider Business Practice Location Address
First Line	:	16623 N WEST POINT PKWY
Second Line	:
City	:	SURPRISE
State	:	AZ
Zip	:	85374-6011
Country	:	US
Telephone Number	:	623-975-0880
Fax Number	:	623-975-6031

Authorized Official
Title or Position	:	MANAGER
Name	:	MRS. MELBA JOYCE WHITE
Credential	:	LPN
Telephone Number	:	623-975-0880

Provider Enumeration Date	:	05/23/2007
Last Update Date	:	08/22/2020

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