| Organization Name: | PHOENIX SENIOR LIVING LLC |
| NPI Number: | 1154541324 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JON M HARDER (MANAGER) |
| Mailing Address: | 12322 N 13th Avenue Youngtown |
| State: | AZ US |
| Postal Code: | 85363 |
| Phone Number: | 6235832460 |
| Fax Number: | 5034851279 |
| NPI Enumeration Date: | 04/27/2007 |
| NPI Last Update Date: | 07/23/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 311500000X |
| License Number: | ALC5613 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | AZ |
| Taxonomy Type: | Nursing & Custodial Care Facilities |
| Taxonomy Classification: | Alzheimer Center (Dementia Center) |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A freestanding facility or special care unit of a long term care facility focusing on patient care of individuals diagnosed with dementia or Alzheimer |