Provider Demographics
NPI:1033444633
Name:GLENDALE HEALTHCARE ASSOC., LLC
Entity Type:Organization
Organization Name:GLENDALE HEALTHCARE ASSOC., LLC
Other - Org Name:DESERT SKY HEALTH AND REHABILITATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF REHAB
Authorized Official - Prefix:
Authorized Official - First Name:TIM
Authorized Official - Middle Name:
Authorized Official - Last Name:RITER
Authorized Official - Suffix:
Authorized Official - Credentials:COTA
Authorized Official - Phone:623-931-5800
Mailing Address - Street 1:5125 N 58TH AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85301-7453
Mailing Address - Country:US
Mailing Address - Phone:623-931-5800
Mailing Address - Fax:623-931-8776
Practice Address - Street 1:5125 N 58TH AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85301-7453
Practice Address - Country:US
Practice Address - Phone:623-931-5800
Practice Address - Fax:623-931-8776
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GLENDALE HEALTHCARE ASSOCIATES, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-10-15
Last Update Date:2009-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZOTC 3638314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ035092OtherMEDICARE
AZ688070Medicaid