Provider Demographics
NPI:1801248463
Name:ARROWHEAD SENIOR LIVING, LLC
Entity type:Organization
Organization Name:ARROWHEAD SENIOR LIVING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:DIEDRICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-818-2310
Mailing Address - Street 1:7886 W PIUTE AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-6167
Mailing Address - Country:US
Mailing Address - Phone:602-818-2310
Mailing Address - Fax:623-388-6704
Practice Address - Street 1:7874 W CALAVAR RD
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-4669
Practice Address - Country:US
Practice Address - Phone:602-818-2310
Practice Address - Fax:623-388-6704
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-07
Last Update Date:2016-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAL10052H310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZA91930156Medicaid
AZA92120782Medicaid