Provider Demographics
NPI:1497808034
Name:SHOLT CORPORATION
Entity Type:Organization
Organization Name:SHOLT CORPORATION
Other - Org Name:ASSISTED LIVING BY SHOLT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:H
Authorized Official - Last Name:HOLT
Authorized Official - Suffix:
Authorized Official - Credentials:BS, MS, LPC
Authorized Official - Phone:480-705-9124
Mailing Address - Street 1:660 N BECK AVE
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85226-1744
Mailing Address - Country:US
Mailing Address - Phone:480-705-9124
Mailing Address - Fax:480-522-1919
Practice Address - Street 1:660 N BECK AVE
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85226-1744
Practice Address - Country:US
Practice Address - Phone:480-705-9124
Practice Address - Fax:480-522-1919
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZALH52173104A0630X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0630XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Behavioral Disturbances
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ946626Medicaid