Provider Demographics
NPI:1821896671
Name:SANCTUARY 1 ASSISTED LIVING
Entity type:Organization
Organization Name:SANCTUARY 1 ASSISTED LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:L
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:ASSISTED LIVING MANA
Authorized Official - Phone:623-632-7171
Mailing Address - Street 1:3870 W ALAMEDA RD
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85310-3302
Mailing Address - Country:US
Mailing Address - Phone:623-434-2185
Mailing Address - Fax:
Practice Address - Street 1:3870 W ALAMEDA RD
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85310-3302
Practice Address - Country:US
Practice Address - Phone:623-434-2185
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-06
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0630XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Behavioral Disturbances