Provider Demographics
NPI:1538643242
Name:NEL'S NEST ASSISTED LIVING , LLC
Entity Type:Organization
Organization Name:NEL'S NEST ASSISTED LIVING , LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CARON
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-882-2766
Mailing Address - Street 1:3655 W DYNAMITE BLVD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85083-0860
Mailing Address - Country:US
Mailing Address - Phone:602-882-2766
Mailing Address - Fax:623-321-9960
Practice Address - Street 1:3655 W DYNAMITE BLVD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85083-0860
Practice Address - Country:US
Practice Address - Phone:602-882-2766
Practice Address - Fax:623-321-9960
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-18
Last Update Date:2018-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility