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Organization
HACIENDA SKILLED NURSING FACILITY, INC.
Active
Organization
HACIENDA SKILLED NURSING FACILITY, INC.
Active
Other names
Hacienda, Inc.
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DALE NORMAN SKURDAHL MA IN EDUCATION (CHIEF OPERATING OFFICER - MED SERV.)
(602) 243-4231
Entity
Organization
Contact information
Practice address
1402 E SOUTH MOUNTAIN AVE, PHOENIX, AZ 85042-7925
(602) 243-4231
(602) 323-5988
Mailing address
1402 E SOUTH MOUNTAIN AVE, PHOENIX, AZ 85042-7925
(602) 243-4231
(602) 323-5988
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
NCI-2617
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
544032
—
AZ
Enumeration date
10/20/2005
Last updated
08/22/2020
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