Provider Demographics
NPI:1174177422
Name:ASSYRIAN CULTURAL FOUNDATION OF ARIZONA
Entity type:Organization
Organization Name:ASSYRIAN CULTURAL FOUNDATION OF ARIZONA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:DAKOF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-863-3566
Mailing Address - Street 1:9163 WEST UNION HILLS DRIVE
Mailing Address - Street 2:SUITE 114 AND 115
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85382
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9163 WEST UNION HILLS DRIVE
Practice Address - Street 2:SUITE 114 AND 115
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85382
Practice Address - Country:US
Practice Address - Phone:480-712-8772
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-25
Last Update Date:2019-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376J00000XNursing Service Related ProvidersHomemakerGroup - Single Specialty