# HACIENDA SKILLED NURSING FACILITY, INC.

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Hacienda, Inc.
- **Organization subpart:** No

## Provider details

- **NPI number:** 1710976956
- **Authorized official:** MR. DALE NORMAN SKURDAHL MA IN EDUCATION (CHIEF OPERATING OFFICER - MED SERV.)
- **Authorized official phone:** (602) 243-4231

## Contact information

- **Practice address:** 1402 E SOUTH MOUNTAIN AVE, PHOENIX, AZ 85042-7925
- **Practice address phone:** (602) 243-4231
- **Practice address fax:** (602) 323-5988
- **Mailing address:** 1402 E SOUTH MOUNTAIN AVE, PHOENIX, AZ 85042-7925
- **Mailing address phone:** (602) 243-4231
- **Mailing address fax:** (602) 323-5988

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | NCI-2617 | AZ | Yes |

## Other

- **Enumeration date:** 10/20/2005
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 544032 | — | AZ |