Provider Demographics
NPI:1437512084
Name:DIGNITY LIVING CENTERS OF NORTH AMERICA PALO VERDE
Entity type:Organization
Organization Name:DIGNITY LIVING CENTERS OF NORTH AMERICA PALO VERDE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:ANNA
Authorized Official - Last Name:HENDERSHOTT
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:480-524-3422
Mailing Address - Street 1:4614 W PALO VERDE DR
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85301-6249
Mailing Address - Country:US
Mailing Address - Phone:623-934-0094
Mailing Address - Fax:480-247-5288
Practice Address - Street 1:4614 W PALO VERDE DR
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85301-6249
Practice Address - Country:US
Practice Address - Phone:623-934-0094
Practice Address - Fax:480-247-5288
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DIGNITY LIVING CENTERS OF NORTH AMERICA PALO VERDE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-03-31
Last Update Date:2016-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN153739101YM0800X, 104100000X, 163W00000X, 163WA2000X, 163WC0400X, 163WP0809X, 163WW0000X, 164W00000X, 313M00000X, 3747P1801X, 376K00000X, 163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral PracticeGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty
No163WA2000XNursing Service ProvidersRegistered NurseAdministratorGroup - Multi-Specialty
No163WC0400XNursing Service ProvidersRegistered NurseCase ManagementGroup - Multi-Specialty
No163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, AdultGroup - Multi-Specialty
No163WW0000XNursing Service ProvidersRegistered NurseWound CareGroup - Multi-Specialty
No164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Multi-Specialty
No313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care FacilityGroup - Multi-Specialty
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty
No376K00000XNursing Service Related ProvidersNurse's AideGroup - Multi-Specialty