HACIENDA SKILLED NURSING FACILITY
Transportation at South Mountain Ave, Phoenix, AZ

License number
Arizona LTC 0195
Category
Nursing
Type
Nursing Care, Pediatric
License number
Arizona LTC 0195
Category
Transportation
Type
Non-emergency Medical Transport (VAN)
Owner
Name: MR. DALE NORMAN SKURDAHL
Title: CHIEF OPERATING OFFICER
Phone: (602) 243-4231
Address
Address
1402 SOUTH South Mountain Ave, Phoenix, AZ 85042
National Provider ID: 1831322676
LicenseFiles verified this license of Nov 7, 2017 at the National Plan and Provider Enumeration System.

Organization information

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HACIENDA SKILLED NURSING FACILITY

1402 E South Mtn Ave, Phoenix, AZ

Registration:
May 22, 2014
Phone:
(602) 243-4231 (Phone)
State ID:
598692
Business type:
Trade Name
Owner:
Hacienda Skilled Nursing Facility, Inc (Owner), 1402 E South Mtn Ave, Phoenix, AZ 85042 (Physical)

HACIENDA SKILLED NURSING FACILITY, INC

1402 E South Mtn Ave, Phoenix, AZ 85042

Industry:
Skilled Nursing Care Facility
Registration:
Feb 19, 2004
State ID:
-1118542-9
Expiration:
PERPETUAL
Chief Executive Officers:
Tom Pomeroy (Other officer), 65 Biltmore Est, Phoenix, AZ 85016 (Physical),Dick Kaupie (President), 16714 N 50 Way, Scottsdale, AZ 85254 (Physical),Ralph Wallork (Treasurer), 9004 E Pershing Ave, Scottsdale, AZ 85260 (Physical),...
Agent:
National Registered Agents Inc,2390 E Camelback Rd, Phoenix, AZ 85016 (Physical)

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