1154623247 NPI number — DOCTOR'S CHOICE ASSISTED LIVING

Table of content: JENNA TAYLOR RUPLE MD (NPI 1437418589)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154623247 NPI number — DOCTOR'S CHOICE ASSISTED LIVING

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DOCTOR'S CHOICE ASSISTED LIVING
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1154623247
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/23/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6518 E OMEGA ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MESA
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85215-1052
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
602-316-6114
Provider Business Mailing Address Fax Number:
480-830-6646

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9101 E BROWN RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MESA
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85207-4350
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-316-6114
Provider Business Practice Location Address Fax Number:
480-830-6646
Provider Enumeration Date:
11/23/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
HAVILAND
Authorized Official First Name:
RACHELLE
Authorized Official Middle Name:
LYNN
Authorized Official Title or Position:
VP/ OWNER OPERATOR/ CERTIFIED MNGR
Authorized Official Telephone Number:
602-326-6114

Provider Taxonomy Codes

  • Taxonomy code: 310400000X , with the licence number:  AL7537C , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: AL7537C . This is a "ARIZONA DEPT. OF HEALTH SERVICES ASSISTED LIVING CENTER NUMBER" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".