| NPI | 1659565034 |
|---|---|
| Doing Business As | SHADOW RIDGE VILLA |
| Entity Type | Organization |
| Authorized Contact | MELCA AZCARRAGA MEDINA Manager/Owner 480-628-5923 |
| Organization Subpart ? | No |
| Primary Taxonomy | 311ZA0620X Custodial Care Facility, Adult Care Home (Licence: AZ ALF6599) |
| Enumeration Date | 2007-08-29 |
| Last Update Date | 2007-08-29 |