Provider Demographics
NPI:1700164308
Name:CORDIA SERVICES LLC
Entity Type:Organization
Organization Name:CORDIA SERVICES LLC
Other - Org Name:CORDIAL ADULT CARE HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RICARDO
Authorized Official - Middle Name:
Authorized Official - Last Name:DIAZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-280-0442
Mailing Address - Street 1:4205 N 7TH AVE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85013-3078
Mailing Address - Country:US
Mailing Address - Phone:602-368-1725
Mailing Address - Fax:
Practice Address - Street 1:3626 W HADLEY ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85009-5559
Practice Address - Country:US
Practice Address - Phone:602-368-1725
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-30
Last Update Date:2011-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home