Provider Demographics
NPI:1689914103
Name:ARCHIE HENDRICKS SR. SKILLED NURSING FACILITY
Entity Type:Organization
Organization Name:ARCHIE HENDRICKS SR. SKILLED NURSING FACILITY
Other - Org Name:TOHONO O'ODHAM ELDER ASSISTED LIVING RESIDENCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO/BUSINESS OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:CHASTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-361-1804
Mailing Address - Street 1:HC 1 BOX 9100
Mailing Address - Street 2:
Mailing Address - City:SELLS
Mailing Address - State:AZ
Mailing Address - Zip Code:85634-9744
Mailing Address - Country:US
Mailing Address - Phone:520-361-1800
Mailing Address - Fax:520-361-3656
Practice Address - Street 1:MILEPOST 9, FEDERAL ROUTE 15
Practice Address - Street 2:
Practice Address - City:SELLS
Practice Address - State:AZ
Practice Address - Zip Code:85634
Practice Address - Country:US
Practice Address - Phone:520-361-1800
Practice Address - Fax:520-361-3656
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-20
Last Update Date:2013-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility