Provider Demographics
NPI:1780324418
Name:PALM VALLEY SENIOR LIVING LLC
Entity type:Organization
Organization Name:PALM VALLEY SENIOR LIVING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ROMEGA THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-263-0015
Mailing Address - Street 1:13616 W ROANOKE AVE
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85395-2236
Mailing Address - Country:US
Mailing Address - Phone:623-259-9431
Mailing Address - Fax:
Practice Address - Street 1:13616 W ROANOKE AVE
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85395-2236
Practice Address - Country:US
Practice Address - Phone:623-259-9431
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-30
Last Update Date:2022-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility