Provider Demographics
NPI:1679284103
Name:TODD, MARITESS (OWNER)
Entity type:Individual
Prefix:
First Name:MARITESS
Middle Name:
Last Name:TODD
Suffix:
Gender:F
Credentials:OWNER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12422 N 88TH DR
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381-8172
Mailing Address - Country:US
Mailing Address - Phone:623-200-9675
Mailing Address - Fax:623-979-5187
Practice Address - Street 1:12422 N 88TH DR
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-8172
Practice Address - Country:US
Practice Address - Phone:623-200-9675
Practice Address - Fax:623-979-5187
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-06
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAL12278H310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility