Provider Demographics
NPI:1073503777
Name:ARCHIE HENDRICKS SR SKILLED NURSING FACILITY
Entity type:Organization
Organization Name:ARCHIE HENDRICKS SR SKILLED NURSING FACILITY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ROSS
Authorized Official - Middle Name:
Authorized Official - Last Name:WILKOFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-585-5500
Mailing Address - Street 1:HC 01 BOX 9100
Mailing Address - Street 2:
Mailing Address - City:SELLS
Mailing Address - State:AZ
Mailing Address - Zip Code:85634
Mailing Address - Country:US
Mailing Address - Phone:520-585-5500
Mailing Address - Fax:520-585-5510
Practice Address - Street 1:HC 01 BOX 9100
Practice Address - Street 2:
Practice Address - City:SELLS
Practice Address - State:AZ
Practice Address - Zip Code:85634
Practice Address - Country:US
Practice Address - Phone:520-361-1800
Practice Address - Fax:520-361-3656
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-24
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ917651Medicaid
AZ917651Medicaid
AZ031576Medicare Oscar/Certification