Provider Demographics
NPI:1639663271
Name:HOLY NAME ASSISTED LIVING, LLC
Entity Type:Organization
Organization Name:HOLY NAME ASSISTED LIVING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LOVELY
Authorized Official - Middle Name:
Authorized Official - Last Name:TANGLAO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-912-5388
Mailing Address - Street 1:112 S NEBRASKA ST
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85225-9561
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:112 S NEBRASKA ST
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85225-9561
Practice Address - Country:US
Practice Address - Phone:480-912-5388
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-18
Last Update Date:2018-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility