Provider Demographics
NPI:1093019770
Name:CC PDR SILVERSTONE L L C
Entity Type:Organization
Organization Name:CC PDR SILVERSTONE L L C
Other - Org Name:VI AT SILVERSTONE, A VI AND PLAZA COMPANIES COMMUNITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SVP & GENERAL COUNSEL
Authorized Official - Prefix:
Authorized Official - First Name:TARA
Authorized Official - Middle Name:
Authorized Official - Last Name:COPE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-803-8555
Mailing Address - Street 1:22605 N 74TH ST
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85255-7500
Mailing Address - Country:US
Mailing Address - Phone:480-478-6200
Mailing Address - Fax:480-478-6297
Practice Address - Street 1:22605 N 74TH ST
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85255-7466
Practice Address - Country:US
Practice Address - Phone:480-478-6200
Practice Address - Fax:480-478-6297
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-10
Last Update Date:2019-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZNCI-2695314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ035281Medicare Oscar/Certification