Provider Demographics
NPI:1023007515
Name:FRIENDSHIP RETIREMENT CORPORATION
Entity Type:Organization
Organization Name:FRIENDSHIP RETIREMENT CORPORATION
Other - Org Name:GLENCROFT CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT OF FINANCE/CFO
Authorized Official - Prefix:MS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:HORNBOSTEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-847-3006
Mailing Address - Street 1:8611 N 67TH AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85302-4351
Mailing Address - Country:US
Mailing Address - Phone:623-939-9475
Mailing Address - Fax:
Practice Address - Street 1:8641 N 67TH AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85302-4308
Practice Address - Country:US
Practice Address - Phone:623-939-9475
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-17
Last Update Date:2008-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZNCI-334314000000X
AZOTC-2874314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ040410Medicaid
AZ=========OtherMANAGED CARE
AZ03-5154Medicare ID - Type UnspecifiedMEDICARE NUMBER
AZ040410Medicaid