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Name of Property:
 

 Description of Property: (no more than 50 words):

 

Contact Information:    

Name:   Title:

Address:  

City:    State:   Zip: 

Phone
:    Fax:   Email: 


Owned and Operated by:    

Name:   Title:

Address:

City:   State:   Zip: 

Other Information:    

Years in Service: 

Services Offered (included in base rate): 
Maintenance
Housekeeping
Utilities (except phone)
Schedule Transportation
Daily Activities
Furnishing Available
3 Meals/2 Snacks
Medication Management
Other Services Available (ala carte):
Escorts
Transportation
Laundry Service
Extra Housekeeping
Companion Service
Hospice
Respite
Amenities:
Beauty shop
Pool
Library
Computers
Private Dining Room
Wellness Center
High Speed Internet Connections
Concierge Services
Activities:
Outings
Concerts
Restaurant
Church
Type of Residence:
Assisted Living Home (10 beds or less; private residence)           
Assisted Living Center (11 beds or more; apartment style residence)
 
Rooms Available:
Private       
Semi-Private
Assisted Living Level of Care:
Supervisory           
Personal           
Directed
Pricing: 
Up to $1500   
$1501 - $2000   
$2001 - $2500   
$2501 - $3000   
Over $3000
 
Extra Person Charge:
$100   
$500   
$1000
 
ALTCS Accepts:  No  Yes 

Pets Allowed:              No  Yes 
 
Provider Logo:

If you would like your logo included on your provider page, please send it to ksbarno@azalfa.org and reference the name of property used on this form.  Images must be in .gif or .jpg format.

 

 


Arizona ALFA
333 East Virginia Avenue #106, Phoenix, AZ 85004

Phone: 602/322-0100
Fax: 602/322-0118
info@azalfa.org