Organization
SURPRISE RESIDENTIAL ASSISTED LIVING
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHAIBA BARRY REGISTERED NURSE (MANAGER)
(602) 404-8196
Entity
Organization
Contact information
Practice address
17218 W STATLER ST, SURPRISE, AZ 85388-1265
(602) 369-1254
(602) 595-1659
Mailing address
17633 N 14TH ST, PHOENIX, AZ 85022-2001
(602) 404-8196
(602) 595-1659
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
—
AZ
Other
Enumeration date
04/20/2007
Last updated
08/22/2020
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