Provider Demographics
NPI:1003185513
Name:THOMAS ROAD SENIOR HOUSING, INC.
Entity Type:Organization
Organization Name:THOMAS ROAD SENIOR HOUSING, INC.
Other - Org Name:ROSE COURT SENIOR LIVING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:LEE
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-401-1369
Mailing Address - Street 1:2935 N 18TH PL
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-7726
Mailing Address - Country:US
Mailing Address - Phone:602-265-9813
Mailing Address - Fax:602-277-9779
Practice Address - Street 1:2935 N 18TH PL
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-7726
Practice Address - Country:US
Practice Address - Phone:602-265-9813
Practice Address - Fax:602-277-9779
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-29
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAL8381OtherFACILITY LICENSE