Individual
SAM ILE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
40401 N. COPPER BASIN TRAIL, ANTHEM, AZ 85086-8508
(602) 909-9550
(623) 321-8797
Mailing address
39506 N. DAISY MOUNTAIN DRIVE, STE 122-627, ANTHEM, AZ 85086
(602) 909-9550
(623) 321-8797
Taxonomy
Speciality
Code
Description
License number
State
3104A0630X
Assisted Living Facility (Behavioral Disturbances)
Primary
—
—
Other
Enumeration date
03/20/2019
Last updated
03/20/2019
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