Organization
CACTUS WREN ASSISTED HOME CARE LLC
Active
Other names
Cactus Wren Assisted Home Care II
Organization subpart
No
Provider details
NPI number
Authorized official
MISS SHIRLETA CANOY SODEN R.N. (OWNER)
(602) 741-5526
Entity
Organization
Contact information
Practice address
6313 N 40TH DRIVE, PHOENIX, AZ 85019-1427
(602) 741-5523
Mailing address
6313 N 40TH DR, PHOENIX, AZ 85019-1427
(602) 741-5523
Taxonomy
Speciality
Code
Description
License number
State
311ZA0620X
Adult Care Home Facility
Primary
ALH-5184
AZ
311ZA0620X
Adult Care Home Facility
ALH-5818
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
113906
—
AZ
05
—
943771
—
AZ
Enumeration date
11/13/2006
Last updated
08/22/2020
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