Organization
PROVIDENCE MANOIR ASSISTED LIVING
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JEAN-MARIE CHARLES (DIRECTOR OF ADMISSIONS)
(480) 388-1140
Entity
Organization
Contact information
Practice address
6567 S GARNET WAY, CHANDLER, AZ 85249-7255
(480) 388-1140
(480) 219-1889
Mailing address
6567 S GARNET WAY, CHANDLER, AZ 85249-7255
(480) 388-1140
(480) 219-1889
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
ALH-5829
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
162761
ALTCS PROVIDER
AZ
Enumeration date
06/09/2007
Last updated
11/05/2007
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