Organization · Type 2 NPI

Hacienda Skilled Nursing Facility, Inc.

Skilled Nursing Facility · Phoenix, AZ

NPI number 1710976956 Active

Practice location

1402 E South Mountain Ave
Phoenix, AZ 85042-7925

Fax (602) 323-5988

Specialties and licenses

Taxonomy	Code	License
Skilled Nursing Facility Primary	314000000X	NCI-2617 (AZ)

Skilled Nursing Facility: (1) A skilled nursing facility is a facility or distinct part of an institution whose primary function is to provide medical, continuous nursing, and other health and social services to patients who are not in an acute phase of illness requiring services in a hospital, but who require primary restorative or skilled nursing services on an inpatient basis above the level of intermediate or custodial care in order to r…

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NPI record

NPI: 1710976956
Entity type: Organization (Type 2)
Issued: Oct 20, 2005
Last updated: Aug 22, 2020
Status: Active

Other names

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Hacienda, Inc. · former legal business name

Authorized official

Mr. Dale Norman Skurdahl, MA IN EDUCATION
Chief Operating Officer - Med Serv.
(602) 243-4231

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This page mirrors the public NPPES file. For credentialing or billing, confirm it on the official CMS NPI Registry, and check the license with the state board.

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About NPI 1710976956

Hacienda Skilled Nursing Facility, Inc.'s National Provider Identifier is 1710976956, issued on Oct 20, 2005. The primary taxonomy on file is Skilled Nursing Facility (314000000X), and the practice location is in Phoenix, AZ. The record was last updated on Aug 22, 2020.