Provider Demographics
NPI:1649325432
Name:RUSSELL HAYS
Entity type:Organization
Organization Name:RUSSELL HAYS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:G
Authorized Official - Last Name:HAYS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-626-7349
Mailing Address - Street 1:3540 E CAMPO BELLO DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-2032
Mailing Address - Country:US
Mailing Address - Phone:602-626-7349
Mailing Address - Fax:602-626-7351
Practice Address - Street 1:3540 E CAMPO BELLO DR
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-2032
Practice Address - Country:US
Practice Address - Phone:602-626-7349
Practice Address - Fax:602-626-7351
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2009-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBH27753104A0625X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZBH2775OtherAZ STATE LICENSE
AZBH2959OtherAZ STATE LICENSE
AZ866717Medicaid