Provider Demographics
NPI:1558045252
Name:SGM HEALTHCARE SERVICE
Entity Type:Organization
Organization Name:SGM HEALTHCARE SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:C
Authorized Official - Last Name:ASANTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-570-9259
Mailing Address - Street 1:3637 E PARKVIEW DR
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85295-3699
Mailing Address - Country:US
Mailing Address - Phone:480-570-2593
Mailing Address - Fax:
Practice Address - Street 1:3637 E PARKVIEW DR
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85295-3699
Practice Address - Country:US
Practice Address - Phone:480-570-2593
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-13
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0630XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Behavioral Disturbances