1508395757 NPI number — CSL-CHANDLER, LLC

Table of content: (NPI 1508395757)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508395757 NPI number — CSL-CHANDLER, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CSL-CHANDLER, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
PENNINGTON GARDENS ASSISTED LIVING & MEMORY CARE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1508395757
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/09/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1580 VALLEY RIVER DR STE 260
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EUGENE
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97401-2193
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
541-636-3460
Provider Business Mailing Address Fax Number:
541-636-3797

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
977 S PENNINGTON DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHANDLER
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85224-5658
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-814-9046
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/09/2017

Additional Information

Authorized Official

Authorized Official Last Name:
WILLIS
Authorized Official First Name:
CANDIS
Authorized Official Middle Name:
Authorized Official Title or Position:
REGIONAL DIRECTOR
Authorized Official Telephone Number:
530-605-8841

Provider Taxonomy Codes

  • Taxonomy code: 310400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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