Organization Name: | 19TH AVENUE OPERATIONS, LLC |
NPI Number: | 1649627423 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | TRACY L. CLARK (AUTHORIZED REPRESENTATIVE) |
Mailing Address: | 6246 N 19th Ave Phoenix |
State: | AZ US |
Postal Code: | 850151511 |
Phone Number: | 6024336300 |
Fax Number: | 6024336458 |
NPI Enumeration Date: | 05/20/2016 |
NPI Last Update Date: | 06/07/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 310400000X |
License Number: | AL10014C |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | AZ |
Taxonomy Type: | Nursing & Custodial Care Facilities |
Taxonomy Classification: | Assisted Living Facility |
Taxonomy Specialization: | |
Taxonomy Definition: | A facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being. |