Provider Demographics
NPI:1659565034
Name:NETONE ENTERPRISES, INC.
Entity Type:Organization
Organization Name:NETONE ENTERPRISES, INC.
Other - Org Name:SHADOW RIDGE VILLA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MELCA
Authorized Official - Middle Name:AZCARRAGA
Authorized Official - Last Name:MEDINA
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:480-628-5923
Mailing Address - Street 1:3921 E LEO PL
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85249-5881
Mailing Address - Country:US
Mailing Address - Phone:480-629-8200
Mailing Address - Fax:480-718-7955
Practice Address - Street 1:1259 E MACAW DR
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85297-4527
Practice Address - Country:US
Practice Address - Phone:480-628-5923
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-29
Last Update Date:2007-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZALF6599311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZALH6599OtherDEPARTMENT OF HEALTH