Provider Demographics
NPI:1164014197
Name:ARIZONA SENIOR LIFE LLC
Entity Type:Organization
Organization Name:ARIZONA SENIOR LIFE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LEA
Authorized Official - Middle Name:
Authorized Official - Last Name:TALLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-310-1940
Mailing Address - Street 1:2105 W WEATHERBY WAY
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85286-8443
Mailing Address - Country:US
Mailing Address - Phone:605-310-1940
Mailing Address - Fax:480-659-3825
Practice Address - Street 1:2134 E PALM LN
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85006-2405
Practice Address - Country:US
Practice Address - Phone:602-275-5955
Practice Address - Fax:480-659-3825
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-10
Last Update Date:2021-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health