SHERIDAN GARDEN ASSISTED LIVING HOME (MEDICAL MANAGEMENT SYSTEMS, INC) NPI 1013132919

Assisted Living Facility in Phoenix, AZ

NPI 1013132919 Organization Assisted Living Facility

About SHERIDAN GARDEN ASSISTED LIVING HOME (MEDICAL MANAGEMENT SYSTEMS, INC)

Sheridan Garden Assisted Living Home (medical Management Systems, Inc) is a provider established in Phoenix, Arizona specializing in assisted living facility. The NPI number of Sheridan Garden Assisted Living Home (medical Management Systems, Inc) is 1013132919 and was assigned on April 2007. The practitioner's primary taxonomy code is 310400000X with license number ALH-3178 (AZ). The provider is registered as an organization and their NPI record was last updated one year ago. The provider's is doing business as Sheridan Garden Assisted Living Home. The authorized official of this NPI record is Mr. Carlos N. Jorge Mba (President, Ceo)

NPI

1013132919

Provider NameSHERIDAN GARDEN ASSISTED LIVING HOME (MEDICAL MANAGEMENT SYSTEMS, INC)
Provider Location Address8937 W SHERIDAN ST PHOENIX, AZ 85037
Provider Mailing Address8937 W SHERIDAN ST PHOENIX, AZ 85037
NPI Entity TypeOrganization
Is Sole Proprietor?N/A
Is Organization Subpart?No
Other Organization NameSHERIDAN GARDEN ASSISTED LIVING HOME
Other Name TypeDoing Business As (3)
Enumeration Date04-16-2007
Last Update Date08-22-2020


Primary Taxonomy

Taxonomy Code310400000X
ClassificationAssisted Living Facility
TypeNursing & Custodial Care Facilities
License No.ALH-3178
License StateAZ
Taxonomy DescriptionA facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being.

Business Address

SHERIDAN GARDEN ASSISTED LIVING HOME
8937 W SHERIDAN ST
PHOENIX, AZ
ZIP 85037
Phone: (623) 907-8858

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Mailing Address

SHERIDAN GARDEN ASSISTED LIVING HOME
8937 W SHERIDAN ST
PHOENIX, AZ
ZIP 85037
Phone: (623) 907-8858



Authorized Official

Authorized Official NameMR. CARLOS N. JORGE MBA
Authorized Official TitlePRESIDENT, CEO
Authorized Official Phone(602) 909-9026

Additional Identifiers


Additional identifier(s) currently or formerly used as an identifier for the provider. The codes may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.

Identifier Type / Code Identifier State
698441MEDICAID (05)AZ

NPI Footnotes

What is the National Provider Indentifier (NPI)?
The NPI is 10-position all-numeric identification number assigned by the NPPES to uniquely identify a health care provider.

Provider Location Address
The location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.

Provider Mailing Address
The mailing address of the provider being identified. This address may contain the same information as the provider location address.

Entity Type Code
The code describing the type of health care provider that is being assigned an NPI.
The entity type codes are:
1 = Person: individual human being who furnishes health care;
2 = Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)

What is a Subpart?
Subparts are the components and separate physical locations of organization health care providers. Subpart examples include:
Hospital components include outpatient departments, surgical centers, psychiatric units, and laboratories. These components are often separately licensed or certified by States and may exist at physical locations other than that of the hospital of which they are a component.

Provider Other Organization Name
The other organization name is the alternative last name by which the provider is or has been known (if an individual) or other name by which the organization provider is or has been known. The code identifying the type of other name. The provider other organization name codes are:
1 = former name;
2 = professional name;
3 = doing business as (d/b/ a) name;
4 = former legal business name; :
5 = other.

Provider Enumeration Date
The date the provider was assigned a unique identifier (assigned an NPI).

Last Update Date
The date that a NPI record was last updated or changed.

Primary Taxonomy Code
The primary taxonomy code defines the provider type, classification, and specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.

Authorized Official Name
The name of the person authorized to submit the NPI application or to officially change data for a health care provider.