Rochelle Anderson
Individual provider Active NPI Assisted Living Facility · Phoenix, AZ
NPI 1588094445 · NPPES record last updated Mar 17, 2018
Key facts
- NPI
- 1588094445
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Assisted Living Facility 310400000X
- License
- AL10582F (AZ)
- Practice address
- 3118 W T Ryan LN
Phoenix, AZ 85041-5216 - Phone
- (602) 621-6337
- Fax
- (602) 601-7727
- NPI assigned
- Nov 13, 2013
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| AL9669H | AZ | MD | Contractor |
| AL10582F | AZ | MD | Assisted Living Facility |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Summerhaven Assisted Living Home LLC | Assisted Living Facility | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Contractor | 171W00000X | AL9669H | AZ | |
| Assisted Living Facility | 310400000X | AL10582F | AZ | Yes |
Addresses
Primary practice location
3118 W T Ryan LN
Phoenix, AZ 85041-5216
Mailing address
3118 W T Ryan LN
Phoenix, AZ 85041-5216
Phone (602) 621-6337
Other practice location 1
9928 W Marguerite Ave
Tolleson, AZ 85353-4412
Phone (602) 621-6337
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 82-2200444 | Other | AZ | IRS |
Other names
- Mrs. Rochelle Harris
Other providers in Phoenix, AZ
- Michelle Marie Anderson
- Monica Anderson
- Norma Anderson
- Patrick Anderson
- Rachel Anderson
- Samuel Michal Anderson
- Sara C Anderson
- Sarah Anderson
- Sasha Anderson
- Scott Anderson
All providers in Phoenix, AZ · Assisted Living Facility in Arizona
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 17, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.