Provider Demographics
NPI:1639524598
Name:VERDANT SENIORS PLACE LLC
Entity Type:Organization
Organization Name:VERDANT SENIORS PLACE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MA TERESITA
Authorized Official - Middle Name:PATINO
Authorized Official - Last Name:ISIDERIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-818-6700
Mailing Address - Street 1:8207 W NICOLET AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85303-1822
Mailing Address - Country:US
Mailing Address - Phone:602-818-6700
Mailing Address - Fax:602-715-2257
Practice Address - Street 1:8207 W NICOLET AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85303-1822
Practice Address - Country:US
Practice Address - Phone:602-818-6700
Practice Address - Fax:602-715-2257
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-28
Last Update Date:2016-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAL9850H311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home