Organization
SOUTHERN ASSISTED LIVING, LLC
Active
Other names
SOUTHERN ASSISTED LIVING HOME
Organization subpart
No
Provider details
NPI number
Authorized official
JULIA ERICKSON (OPERATIONS MANAGER)
(602) 426-0332
Entity
Organization
Contact information
Practice address
6013 S 47TH ST, PHOENIX, AZ 85042-5312
(602) 426-0332
(602) 601-7067
Mailing address
6013 S 47TH ST, PHOENIX, AZ 85042-5312
(602) 426-0332
(602) 601-7067
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
AL9327H
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
AL9327H
LICENSE
AZ
Enumeration date
10/24/2017
Last updated
10/24/2017
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