Provider Demographics
NPI:1245973916
Name:TILVAN, MANUELA
Entity type:Individual
Prefix:MS
First Name:MANUELA
Middle Name:
Last Name:TILVAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8546 W JOAN DE ARC AVE
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381-4878
Mailing Address - Country:US
Mailing Address - Phone:623-334-1827
Mailing Address - Fax:623-486-4680
Practice Address - Street 1:8546 W JOAN DE ARC AVE
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-4878
Practice Address - Country:US
Practice Address - Phone:623-606-8975
Practice Address - Fax:623-486-4680
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-19
Last Update Date:2022-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAL4125H310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility