Provider Demographics
NPI:1205459047
Name:AZALEA VILLA ASSISTED LIVING CENTER
Entity type:Organization
Organization Name:AZALEA VILLA ASSISTED LIVING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:CONSUELO
Authorized Official - Last Name:HEYWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:MANAGER
Authorized Official - Phone:480-430-4475
Mailing Address - Street 1:707 W PALO VERDE ST
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85233-5841
Mailing Address - Country:US
Mailing Address - Phone:480-430-4475
Mailing Address - Fax:480-539-2797
Practice Address - Street 1:217 N WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85225-5514
Practice Address - Country:US
Practice Address - Phone:480-899-5306
Practice Address - Fax:480-855-5193
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-27
Last Update Date:2020-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZALM-009151OtherARIZONA NCIA BOARD