Provider Demographics
NPI:1578353298
Name:EL PUEBLO ASSISTED LIVING LLC
Entity type:Organization
Organization Name:EL PUEBLO ASSISTED LIVING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VALENTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:AIKHU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-338-4284
Mailing Address - Street 1:14030 N EL PUEBLO BLVD
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN HILLS
Mailing Address - State:AZ
Mailing Address - Zip Code:85268-3221
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:14030 N EL PUEBLO BLVD
Practice Address - Street 2:
Practice Address - City:FOUNTAIN HILLS
Practice Address - State:AZ
Practice Address - Zip Code:85268-3221
Practice Address - Country:US
Practice Address - Phone:747-338-4284
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-07
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility