15810 South 42nd Street Operations LLC
Skilled Nursing Facility in Phoenix, AZ. Organization (NPI-2).
NPI number1184105850
StatusActive
Last updated in NPPESAug 22, 2018
Details
- NPI
- 1184105850
- Entity type
- Organization (NPI-2)
- Legal business name
- 15810 South 42nd Street Operations LLC
- Organization subpart
- No
- Enumeration date
- Aug 22, 2018
- Last updated
- Aug 22, 2018
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 314000000X | Skilled Nursing Facility | – | – | Yes |
Other names
- La Estancia Nursing And Rehabilitation Center (Doing Business As)
Practice location
15810 S 42nd StPhoenix, AZ 85048-7409
Phone 480-759-0358
Mailing address
101 E State StKennett Square, PA 19348-3109
Phone 610-925-2254
Authorized official
Michael Berg
Assistant Secretary
6109252254
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