Provider Demographics
NPI:1265079560
Name:HUSHABYE NURSERY
Entity type:Organization
Organization Name:HUSHABYE NURSERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:TARA
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:SUNDEM
Authorized Official - Suffix:
Authorized Official - Credentials:RN NNP-BC MSN
Authorized Official - Phone:480-628-7500
Mailing Address - Street 1:2473 S HIGLEY RD STE 104
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85295-1103
Mailing Address - Country:US
Mailing Address - Phone:480-628-7500
Mailing Address - Fax:
Practice Address - Street 1:3003 E MCDOWELL RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85008-3620
Practice Address - Country:US
Practice Address - Phone:480-628-7500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HUSHABYE NURSERY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-12-05
Last Update Date:2020-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder