Provider Demographics
NPI:1174330344
Name:SONORAN FOOTHILLS ASSISTED LIVING LLC
Entity type:Organization
Organization Name:SONORAN FOOTHILLS ASSISTED LIVING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARCELA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOGDAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-208-4354
Mailing Address - Street 1:1830 W DUSTY WREN DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85085-8061
Mailing Address - Country:US
Mailing Address - Phone:480-208-4354
Mailing Address - Fax:480-685-3134
Practice Address - Street 1:1830 W DUSTY WREN DR
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85085-8061
Practice Address - Country:US
Practice Address - Phone:480-208-4354
Practice Address - Fax:480-685-3134
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-11
Last Update Date:2025-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility