Provider Demographics
NPI:1225659493
Name:MAYORDO, ROSEMARY T (FOSTER HOME)
Entity Type:Individual
Prefix:
First Name:ROSEMARY
Middle Name:T
Last Name:MAYORDO
Suffix:
Gender:F
Credentials:FOSTER HOME
Other - Prefix:
Other - First Name:AT-HOME AT SIENNA
Other - Middle Name:HILLS
Other - Last Name:LLC
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:21210 W HOLLY ST
Mailing Address - Street 2:
Mailing Address - City:BUCKEYE
Mailing Address - State:AZ
Mailing Address - Zip Code:85396-2367
Mailing Address - Country:US
Mailing Address - Phone:206-383-3905
Mailing Address - Fax:
Practice Address - Street 1:21210 W HOLLY ST
Practice Address - Street 2:
Practice Address - City:BUCKEYE
Practice Address - State:AZ
Practice Address - Zip Code:85396-2367
Practice Address - Country:US
Practice Address - Phone:206-383-3905
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-29
Last Update Date:2020-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAL11408F310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility