Provider Demographics
NPI:1336849801
Name:ANDREICA, ELEONORA
Entity Type:Individual
Prefix:
First Name:ELEONORA
Middle Name:
Last Name:ANDREICA
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 1:15313 N 87TH DR
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381-3734
Mailing Address - Country:US
Mailing Address - Phone:503-939-0308
Mailing Address - Fax:
Practice Address - Street 1:6121 W FOOTHILL DR
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85310-4211
Practice Address - Country:US
Practice Address - Phone:623-266-9819
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-03
Last Update Date:2023-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZALM-012438310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility