Provider Demographics
NPI:1578773610
Name:GLORIA DORSETT
Entity Type:Organization
Organization Name:GLORIA DORSETT
Other - Org Name:DORSETT RESIDENCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CARE HOME OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:ANNA
Authorized Official - Last Name:DORSETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-996-7450
Mailing Address - Street 1:4935 E ACOMA DR
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-2246
Mailing Address - Country:US
Mailing Address - Phone:602-996-7450
Mailing Address - Fax:602-996-7450
Practice Address - Street 1:4935 E ACOMA DR
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85254-2246
Practice Address - Country:US
Practice Address - Phone:602-996-7450
Practice Address - Fax:602-996-7450
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAFC-5413320700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities