Provider Demographics
NPI:1730444647
Name:HARRAWAY CORPORATION
Entity type:Organization
Organization Name:HARRAWAY CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MRS
Authorized Official - First Name:YVETTE
Authorized Official - Middle Name:VERA
Authorized Official - Last Name:HARRAWAY
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:623-810-2225
Mailing Address - Street 1:10214 N 89TH AVE
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85345-6467
Mailing Address - Country:US
Mailing Address - Phone:623-810-2225
Mailing Address - Fax:623-979-4465
Practice Address - Street 1:10214 N 89TH AVE
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85345-6467
Practice Address - Country:US
Practice Address - Phone:623-979-4717
Practice Address - Fax:623-979-4465
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-06
Last Update Date:2012-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAL6125H310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ177551Medicaid