Provider Demographics
NPI:1780996322
Name:GKKCO DBA VALENCIA SAVOUR ALH
Entity type:Organization
Organization Name:GKKCO DBA VALENCIA SAVOUR ALH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:NATALYA
Authorized Official - Middle Name:
Authorized Official - Last Name:URAYEVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-367-6868
Mailing Address - Street 1:1625 E MONTOYA LN
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85024-4325
Mailing Address - Country:US
Mailing Address - Phone:623-516-0185
Mailing Address - Fax:
Practice Address - Street 1:1625 E MONTOYA LN
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85024-4325
Practice Address - Country:US
Practice Address - Phone:623-516-0185
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GLOBAL KEYS TO KNOWLEDGE CO
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-07-12
Last Update Date:2010-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAL8034H310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility