Organization
ST. MICHAEL'S MANOR
Active
Other names
TERESITA And MARIO CABACUNGAN
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. TERESITA ARCENA CABACUNGAN (OWNER)
(562) 673-3214
Entity
Organization
Contact information
Practice address
8449 W SHAW BUTTE DR, PEORIA, AZ 85345-8160
(623) 486-5987
(623) 328-5530
Mailing address
8449 W SHAW BUTTE DR, PEORIA, AZ 85345-8160
(623) 486-5987
(623) 328-5530
Taxonomy
Speciality
Code
Description
License number
State
311ZA0620X
Adult Care Home Facility
Primary
ALH-4384
AZ
311ZA0620X
Adult Care Home Facility
ALH-5308
AZ
311ZA0620X
Adult Care Home Facility
ALH6365
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
827777
AHCCCS
AZ
01
—
966244
AHCCCS
AZ
Enumeration date
11/09/2006
Last updated
05/31/2008
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