Organization
NINA NETTLES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. NINA FAE NETTLES (ADMINISTRATOR)
(602) 867-7500
Entity
Organization
Contact information
Practice address
3643 E EMILE ZOLA AVE, PHOENIX, AZ 85032-6219
(602) 867-7500
Mailing address
3643 E EMILE ZOLA AVE, PHOENIX, AZ 85032-6219
(602) 867-7500
Taxonomy
Speciality
Code
Description
License number
State
3104A0625X
Assisted Living Facility (Mental Illness)
Primary
BH2458
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
873936
—
AZ
01
—
BH2458
STATE LICENCE
AZ
Enumeration date
01/30/2007
Last updated
06/16/2008
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