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Hacienda Skilled Nursing Facility
Non-emergency Medical Transport (VAN) in Phoenix, Arizona
NPI 1831322676

Hacienda Skilled Nursing Facility is a Non-emergency Medical Transport (VAN) based in Phoenix, AZ. Hacienda Skilled Nursing Facility practices in Phoenix, AZ. The NPI Number for Hacienda Skilled Nursing Facility is 1831322676 and holds a License No. LTC 0195 (Arizona).

The current practice location address for Hacienda Skilled Nursing Facility is 1402 E South Mountain Ave, Phoenix, AZ and can be reached out via phone at 602-243-4231 and via fax at 602-323-5988.

Location: 1402 E South Mountain Ave, Phoenix, AZ, 85042-7925
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
institution
Provider Profile Details
NPI Number
1831322676
Provider Name
Hacienda Skilled Nursing Facility
Credential
Provider Entity Type
Organization
Address
1402 E South Mountain Ave, Phoenix, AZ, 85042-7925
Phone Number
602-243-4231
Fax Number
602-323-5988
Provider Enumeration Date
08/27/2009
Last Update Date
03/09/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
544032 05 AZ
LTC 0195 01 AZ STATE LICENSE
03D1096517 01 AZ CLIA
institution
Provider Business Practice Location Address Details
Address
1402 E South Mountain Ave
City
Phoenix
State
Arizona
Zip
85042-7925
Phone Number
602-243-4231
Fax Number
602-323-5988
person
Provider Business Mailing Address Details
Address
1402 E South Mountain Ave
City
Phoenix
State
Arizona
Zip
85042-7925
Phone Number
602-243-4231
Fax Number
602-323-5988
person
Provider's Taxonomy Details 1
Type
Nursing & Custodial Care Facilities
Classification
Skilled Nursing Facility
Speciality
Nursing Care, Pediatric
Taxonomy
3140N1450X
License No.
LTC 0195 (Arizona)
Definition
A nursing care facility designed and staffed for the provision of nursing care and appropriate educational and habilitative/rehabilitative services to children with multiple, complex or profound disabilities that can not be cared for in a less restrictive environment.
person
Provider's Taxonomy Details 2
Type
Transportation Services
Classification
Non-emergency Medical Transport (VAN)
Speciality
-
Taxonomy
343900000X
License No.
LTC 0195 (Arizona)
Definition
A land vehicle with a capacity to meet special height, clearance, access, and seating, for the conveyance of persons in non-emergency situations. The vehicle may or may not be required to meet local county or state regulations.
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