Organization
HACIENDA SKILLED NURSING FACILITY
Active
Other names
Hacienda SNF Transport
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DALE NORMAN SKURDAHL (CHIEF OPERATING OFFICER)
(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
3140N1450X
Pediatric Skilled Nursing Facility
LTC 0195
AZ
343900000X
Non-emergency Medical Transport (VAN)
Primary
LTC 0195
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
03D1096517
CLIA
AZ
05
—
544032
—
AZ
01
—
LTC 0195
STATE LICENSE
AZ
Enumeration date
08/27/2009
Last updated
08/27/2009
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Contact us