Provider Demographics
NPI: | 1407287774 |
---|---|
Name: | ADRIAN ASSISTED LIVING |
Entity Type: | Organization |
Organization Name: | ADRIAN ASSISTED LIVING |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | ASSISTED LIVING MANAGER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | ADRIANA |
Authorized Official - Middle Name: | CAMELIA |
Authorized Official - Last Name: | CIRJAN |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 602-595-0604 |
Mailing Address - Street 1: | 607 W VILLA RITA DR |
Mailing Address - Street 2: | |
Mailing Address - City: | PHOENIX |
Mailing Address - State: | AZ |
Mailing Address - Zip Code: | 85023-8103 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 602-687-3804 |
Mailing Address - Fax: | 602-595-0604 |
Practice Address - Street 1: | 607 W VILLA RITA DR |
Practice Address - Street 2: | |
Practice Address - City: | PHOENIX |
Practice Address - State: | AZ |
Practice Address - Zip Code: | 85023-8103 |
Practice Address - Country: | US |
Practice Address - Phone: | 602-687-3804 |
Practice Address - Fax: | 602-595-0604 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2013-12-11 |
Last Update Date: | 2013-12-11 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
AZ | AL8935H | 302R00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 302R00000X | Managed Care Organizations | Health Maintenance Organization |