Hacienda Skilled Nursing Facility, Inc.

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

NCI-2617 Issued in AZ

Legal business name

HACIENDA SKILLED NURSING FACILITY, INC.

Practice address

1402 E South Mountain Ave
Phoenix, AZ 85042-7925

Phone

(602) 243-4231

Fax

(602) 323-5988

NPI assigned

Oct 20, 2005

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Dale Norman Skurdahl, MA IN EDUCATION

Title

Chief Operating Officer - Med Serv.

Phone

(602) 243-4231

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Hacienda, Inc. Former legal business name

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1129766400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1710976956",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1402 E SOUTH MOUNTAIN AVE",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850427925",
            "telephone_number": "602-243-4231",
            "fax_number": "602-323-5988"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1402 E SOUTH MOUNTAIN AVE",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850427925",
            "telephone_number": "602-243-4231",
            "fax_number": "602-323-5988"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HACIENDA SKILLED NURSING FACILITY, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-20",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "SKURDAHL",
        "authorized_official_first_name": "DALE",
        "authorized_official_middle_name": "NORMAN",
        "authorized_official_title_or_position": "CHIEF OPERATING OFFICER - MED SERV.",
        "authorized_official_telephone_number": "602-243-4231",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MA IN EDUCATION"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "AZ",
            "license": "NCI-2617",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "544032",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Hacienda, Inc.",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Makonnen G. Habtemariam, M.D.
• Hassan Hachem, M.D.
• Hacienda Inc
• Hacienda Inc (Hacienda HCBS)
• Hacienda Skilled Nursing Facility (Hacienda SNF Transport)
• Nichole Hackbarth, MSN, RN, CPN
• John David Hacker
• Anita Hackett, CCC-SLP
• George Hackett, MS, ATC, CSCS
• John Peter Hackett III, M.D.

• Skilled Nursing Facility in Phoenix, AZ
• Providers in Phoenix, AZ by specialty
• Skilled Nursing Facility in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.