Provider Demographics
NPI:1154880748
Name:ST WALTER LLC
Entity type:Organization
Organization Name:ST WALTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:MANALO
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:480-326-5143
Mailing Address - Street 1:840 E CANYON WAY
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85249-5348
Mailing Address - Country:US
Mailing Address - Phone:480-326-5143
Mailing Address - Fax:480-775-7713
Practice Address - Street 1:8650 S LOS FELIZ DR
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85284-2583
Practice Address - Country:US
Practice Address - Phone:480-730-9110
Practice Address - Fax:480-775-7713
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-14
Last Update Date:2019-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility