Provider Demographics
NPI:1730691635
Name:APOLLO RAL LLC
Entity type:Organization
Organization Name:APOLLO RAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JORDAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GLENN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:801-310-3031
Mailing Address - Street 1:8405 W DALEY LN
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85383-2013
Mailing Address - Country:US
Mailing Address - Phone:801-310-3031
Mailing Address - Fax:
Practice Address - Street 1:4719 W HARMONT DR
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85302-6416
Practice Address - Country:US
Practice Address - Phone:623-930-6764
Practice Address - Fax:623-930-1233
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-01
Last Update Date:2017-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAL9918H310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility