Provider Demographics
NPI:1134950017
Name:ST. MICHAEL'S MANOR
Entity type:Organization
Organization Name:ST. MICHAEL'S MANOR
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:TERESITA
Authorized Official - Middle Name:ARCENA
Authorized Official - Last Name:CABACUNGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-680-3733
Mailing Address - Street 1:3709 S 77TH LN
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85043-1233
Mailing Address - Country:US
Mailing Address - Phone:623-680-3733
Mailing Address - Fax:
Practice Address - Street 1:3709 S 77TH LN
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85043-1233
Practice Address - Country:US
Practice Address - Phone:623-680-3733
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST. MICHAEL'S MANOR LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-08-12
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
No251J00000XAgenciesNursing Care