Provider Demographics
NPI:1083474704
Name:SODALITY ASSISTED LIVING , LLC
Entity Type:Organization
Organization Name:SODALITY ASSISTED LIVING , LLC
Other - Org Name:SODALITY ASSISTED LIVING LLC
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DENTON
Authorized Official - Middle Name:
Authorized Official - Last Name:DIAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-217-0368
Mailing Address - Street 1:8846 N 30TH AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85051-3919
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8846 N 30TH AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85051-3919
Practice Address - Country:US
Practice Address - Phone:152-070-9464
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-20
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No315D00000XNursing & Custodial Care FacilitiesHospice, Inpatient