Organization
RIVENDELL ENTERPRISES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. RACQUEL P YOUNG (OWNER/MANAGER)
(602) 993-1596
Entity
Organization
Contact information
Practice address
1901 W JOAN DE ARC AVE, PHOENIX, AZ 85029-1616
(602) 993-1596
(602) 993-1440
Mailing address
1901 W JOAN DE ARC AVE, PHOENIX, AZ 85029-1616
(602) 993-1596
(602) 993-1440
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
AL6401H
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
959596
—
AZ
Enumeration date
05/25/2018
Last updated
05/25/2018
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