Provider Demographics
NPI:1023512753
Name:SURPRISE MEMORY CARE, LP
Entity type:Organization
Organization Name:SURPRISE MEMORY CARE, LP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:ROMAYO
Authorized Official - Suffix:
Authorized Official - Credentials:CDP
Authorized Official - Phone:623-266-4999
Mailing Address - Street 1:16465 N PARKVIEW PL
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85374-7494
Mailing Address - Country:US
Mailing Address - Phone:623-266-4999
Mailing Address - Fax:623-251-5022
Practice Address - Street 1:16465 N PARKVIEW PL
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374-7494
Practice Address - Country:US
Practice Address - Phone:623-266-4999
Practice Address - Fax:623-251-5022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-19
Last Update Date:2018-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAL9995C310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility