Provider Demographics
NPI:1558088211
Name:WHITE DOVE
Entity Type:Organization
Organization Name:WHITE DOVE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARINELA
Authorized Official - Middle Name:
Authorized Official - Last Name:BORA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-677-2627
Mailing Address - Street 1:7918 W EMORY LN
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85383-1024
Mailing Address - Country:US
Mailing Address - Phone:602-677-2627
Mailing Address - Fax:
Practice Address - Street 1:23161 N 87TH DR
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85383-1880
Practice Address - Country:US
Practice Address - Phone:602-677-2627
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-24
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility