Organization
HACIENDA SKILLED NURSING FACILITY, INC.
Active
Other names
Hacienda, Inc.
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DALE NORMAN SKURDAHL MA IN EDUCATION (CHIEF OPERATING OFFICER - MED SERV.)
(602) 243-4231
Entity
Organization
Contact information
Practice address
1402 E SOUTH MOUNTAIN AVE, PHOENIX, AZ 85042-7925
(602) 243-4231
(602) 323-5988
Mailing address
1402 E SOUTH MOUNTAIN AVE, PHOENIX, AZ 85042-7925
(602) 243-4231
(602) 323-5988
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
NCI-2617
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
544032
—
AZ
Enumeration date
10/20/2005
Last updated
08/22/2020
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