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
StateLicense IDTaxonomies
AZAL8935H302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization