Provider Demographics
NPI:1154623247
Name:DOCTOR'S CHOICE ASSISTED LIVING
Entity type:Organization
Organization Name:DOCTOR'S CHOICE ASSISTED LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP/ OWNER OPERATOR/ CERTIFIED MNGR
Authorized Official - Prefix:MS
Authorized Official - First Name:RACHELLE
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:HAVILAND
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BS
Authorized Official - Phone:602-326-6114
Mailing Address - Street 1:6518 E OMEGA ST
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85215-1052
Mailing Address - Country:US
Mailing Address - Phone:602-316-6114
Mailing Address - Fax:480-830-6646
Practice Address - Street 1:9101 E BROWN RD
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85207-4350
Practice Address - Country:US
Practice Address - Phone:602-316-6114
Practice Address - Fax:480-830-6646
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-23
Last Update Date:2010-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAL7537C310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAL7537COtherARIZONA DEPT. OF HEALTH SERVICES ASSISTED LIVING CENTER NUMBER