Provider Demographics
NPI:1568147379
Name:AZALEA GARDEN LLC
Entity Type:Organization
Organization Name:AZALEA GARDEN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DEVIN
Authorized Official - Middle Name:CHANDLER
Authorized Official - Last Name:LEES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-994-6699
Mailing Address - Street 1:3300 N PIONEER WAY
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89129-6206
Mailing Address - Country:US
Mailing Address - Phone:702-994-6699
Mailing Address - Fax:
Practice Address - Street 1:3300 N PIONEER WAY
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89129-6206
Practice Address - Country:US
Practice Address - Phone:702-994-6699
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-19
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home