OrganizationActive
Hacienda Inc
NPI 1841513413 · Intellectual Disabilities Intermediate Care Facility · Phoenix, AZ
Provider details
- NPI number
- 1841513413
- Entity type
- Organization
- Primary specialty
- Intellectual Disabilities Intermediate Care FacilityNursing & Custodial Care Facilities
- Authorized official
- Perry Petrilli, Ceo
- License
- DDH1558 (AZ)
Practice location
1402 E South Mountain Ave
Phoenix, AZ 85042-7925
Phone: (602) 243-4231
Fax: (602) 323-5988
Mailing address
1402 E South Mountain Ave
Phoenix, AZ 85042-7925
Registry dates
- Enumerated
- 2010-03-10
- Last updated
- 2025-02-13
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.