Provider Demographics
NPI:1093838658
Name:ARCHIE HENDRICKS SR. SKILLED NURSING FASCILITY
Entity Type:Organization
Organization Name:ARCHIE HENDRICKS SR. SKILLED NURSING FASCILITY
Other - Org Name:TOHONO O'ODHAM HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CONCETTA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:TYNAN
Authorized Official - Suffix:
Authorized Official - Credentials:RN NP
Authorized Official - Phone:520-361-1800
Mailing Address - Street 1:HCO 1 BOX 9100
Mailing Address - Street 2:FEDERAL ROUTE 15, MILE POST 9
Mailing Address - City:SELLS
Mailing Address - State:AZ
Mailing Address - Zip Code:85634-9744
Mailing Address - Country:US
Mailing Address - Phone:520-361-1800
Mailing Address - Fax:520-361-3656
Practice Address - Street 1:FEDERAL ROUTE 15 MILE POST 9
Practice Address - Street 2:
Practice Address - City:SELLS
Practice Address - State:AZ
Practice Address - Zip Code:85634-9744
Practice Address - Country:US
Practice Address - Phone:520-361-1800
Practice Address - Fax:520-361-3656
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ARCHIE HENDRICKS SR. SKILLED NURSING FACILITY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-04-09
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based