Provider Demographics
NPI:1649093741
Name:GIFFITH DOWNER, MISCHELLE LATOYA
Entity type:Individual
Prefix:
First Name:MISCHELLE
Middle Name:LATOYA
Last Name:GIFFITH DOWNER
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 1:19918 N 65TH AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-7088
Mailing Address - Country:US
Mailing Address - Phone:929-789-6403
Mailing Address - Fax:623-201-8546
Practice Address - Street 1:19918 N 65TH AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-7088
Practice Address - Country:US
Practice Address - Phone:929-789-6403
Practice Address - Fax:623-201-8546
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-06
Last Update Date:2024-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAL13092H310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility