Organization
SFC SHANE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHANE M ELSON OWNER (LONG TERM CARE PROVIDER)
(480) 862-5741
Entity
Organization
Contact information
Practice address
460 E OSAGE AVE, 1, APACHE JUNCTION, AZ 85119-3748
(480) 862-5741
Mailing address
11543 E DARTMOUTH ST, MESA, AZ 85207-2355
(480) 862-5741
Taxonomy
Speciality
Code
Description
License number
State
302F00000X
Exclusive Provider Organization
Primary
—
—
Other
Enumeration date
03/25/2016
Last updated
03/25/2016
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