Provider Demographics
NPI:1013629476
Name:VALLEY ASSISTED LIVING
Entity Type:Organization
Organization Name:VALLEY ASSISTED LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAVINIA
Authorized Official - Middle Name:M
Authorized Official - Last Name:CACUCI - SIMIONASI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-248-6577
Mailing Address - Street 1:3122 W CAVEDALE DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85083-8636
Mailing Address - Country:US
Mailing Address - Phone:623-248-6577
Mailing Address - Fax:
Practice Address - Street 1:3122 W CAVEDALE DR
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85083-8636
Practice Address - Country:US
Practice Address - Phone:623-248-6577
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-16
Last Update Date:2022-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ6027037124Medicaid