1144212093 NPI number — SCOTTSDALE RESIDENTIAL CARE INVESTORS

Table of content: (NPI 1144212093)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144212093 NPI number — SCOTTSDALE RESIDENTIAL CARE INVESTORS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SCOTTSDALE RESIDENTIAL CARE INVESTORS
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:
Provider Other Organization Name Type Code:
6
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:
1144212093
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/24/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2620 N 68TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SCOTTSDALE
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85257-1202
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-946-6571
Provider Business Mailing Address Fax Number:
480-946-0082

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2620 NORTH 68TH STREET
Provider Second Line Business Practice Location Address:
MAIN BUILDING
Provider Business Practice Location Address City Name:
SCOTTSDALE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85257-1202
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-946-6571
Provider Business Practice Location Address Fax Number:
480-946-0082
Provider Enumeration Date:
08/17/2005

Additional Information

Authorized Official

Authorized Official Last Name:
BYRUM
Authorized Official First Name:
BARBARA
Authorized Official Middle Name:
A.
Authorized Official Title or Position:
CONTROLLER
Authorized Official Telephone Number:
480-946-6571

Provider Taxonomy Codes

  • Taxonomy code: 3104A0630X , with the licence number:  ALC-5259 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 314000000X , with the licence number: NCI-068 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 426355 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".




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