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Organization

AZ ADVANCED CARE LLC

Active
Other names
West Lane Home
Organization subpart
No

Provider details

NPI number
Authorized official
REBECCA T. SIDDIQUI (ADMINISTRATOR)
(602) 332-0780
Entity
Organization

Contact information

Practice address
3137 W LANE AVE, PHOENIX, AZ 85051-6522
(602) 332-0780
(877) 517-2224
Mailing address
3137 W LANE AVE, PHOENIX, AZ 85051-6522
(602) 332-0780
(877) 517-2224

Taxonomy

Speciality
Code
Description
License number
State
311ZA0620X
Adult Care Home Facility
Primary
AL9510H
AZ

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
963085
AZ
Enumeration date
04/02/2015
Last updated
04/02/2015
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