Provider Demographics
NPI:1811734445
Name:WHITE VIOLET ADULT CARE HOME II LLC
Entity type:Organization
Organization Name:WHITE VIOLET ADULT CARE HOME II LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSEE
Authorized Official - Prefix:MS
Authorized Official - First Name:DINA
Authorized Official - Middle Name:
Authorized Official - Last Name:ARGUILLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-316-5779
Mailing Address - Street 1:3711 W CHOLLA ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85029-3132
Mailing Address - Country:US
Mailing Address - Phone:602-218-6378
Mailing Address - Fax:602-801-3543
Practice Address - Street 1:3711 W CHOLLA ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85029-3132
Practice Address - Country:US
Practice Address - Phone:602-218-6378
Practice Address - Fax:602-801-3543
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-11
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility