Provider Demographics
NPI:1164970059
Name:CORNELIA & IOAN BASA
Entity Type:Organization
Organization Name:CORNELIA & IOAN BASA
Other - Org Name:THE SIERRA'S ASSISTED LIVING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING SUPERVISOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DHANA
Authorized Official - Middle Name:
Authorized Official - Last Name:PRABHU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-338-9699
Mailing Address - Street 1:13330 N 88TH PL
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-7633
Mailing Address - Country:US
Mailing Address - Phone:602-622-1667
Mailing Address - Fax:
Practice Address - Street 1:13330 N 88TH PL
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-7633
Practice Address - Country:US
Practice Address - Phone:602-622-1667
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-20
Last Update Date:2016-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAL4870H310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility