Provider Demographics
NPI:1336662337
Name:HOUSE OF DIGNITY ASSISTED LIVING LLC
Entity Type:Organization
Organization Name:HOUSE OF DIGNITY ASSISTED LIVING LLC
Other - Org Name:HOUSE OF DIGNITY ASSISTED LIVING LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:BOAKYE DANQUAH
Authorized Official - Suffix:
Authorized Official - Credentials:DR
Authorized Official - Phone:480-306-6242
Mailing Address - Street 1:214 W DANISH RED TRL
Mailing Address - Street 2:
Mailing Address - City:SAN TAN VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85143-5517
Mailing Address - Country:US
Mailing Address - Phone:480-306-6242
Mailing Address - Fax:
Practice Address - Street 1:214 W DANISH RED TRL
Practice Address - Street 2:
Practice Address - City:SAN TAN VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85143
Practice Address - Country:US
Practice Address - Phone:480-306-6242
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility