Provider Demographics
NPI:1194554337
Name:PYNE, ALFRED
Entity type:Individual
Prefix:
First Name:ALFRED
Middle Name:
Last Name:PYNE
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1632 W CHANUTE PASS
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85041-3833
Mailing Address - Country:US
Mailing Address - Phone:623-792-0395
Mailing Address - Fax:
Practice Address - Street 1:1632 W CHANUTE PASS
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85041-3833
Practice Address - Country:US
Practice Address - Phone:623-792-0395
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-27
Last Update Date:2025-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAL12855H310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility