Provider Demographics
NPI:1639565922
Name:DIGNITY LIVING CENTERS OF NORTH AMERICA PALO VERDE LLC
Entity Type:Organization
Organization Name:DIGNITY LIVING CENTERS OF NORTH AMERICA PALO VERDE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER/ADMINISTRATOR/MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:ANNA
Authorized Official - Last Name:HENDERSHOTT
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:480-658-6920
Mailing Address - Street 1:4614 W PALO VERDE DR
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85301-6249
Mailing Address - Country:US
Mailing Address - Phone:623-934-0094
Mailing Address - Fax:480-247-5288
Practice Address - Street 1:4614 W PALO VERDE DR
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85301-6249
Practice Address - Country:US
Practice Address - Phone:623-934-0094
Practice Address - Fax:480-247-5288
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-13
Last Update Date:2015-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
No320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities
No323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility