Organization
SKYLARK ACH LLC
Active
Organization
SKYLARK ACH LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PAUL V PETRINI (OWNER)
(602) 486-3001
Entity
Organization
Contact information
Practice address
12034 N 46TH LN, GLENDALE, AZ 85304-3012
(623) 776-1477
Mailing address
12034 N 46TH LN, GLENDALE, AZ 85304-3012
(623) 776-1477
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
—
—
3104A0625X
Assisted Living Facility (Mental Illness)
—
—
3104A0630X
Assisted Living Facility (Behavioral Disturbances)
—
—
Other
Enumeration date
06/02/2015
Last updated
06/02/2015
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