Provider Demographics
NPI:1144212093
Name:SCOTTSDALE RESIDENTIAL CARE INVESTORS
Entity Type:Organization
Organization Name:SCOTTSDALE RESIDENTIAL CARE INVESTORS
Other - Org Name:SCOTTSDALE VILLAGE SQUARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:A
Authorized Official - Last Name:BYRUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-946-6571
Mailing Address - Street 1:2620 N 68TH ST
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85257-1202
Mailing Address - Country:US
Mailing Address - Phone:480-946-6571
Mailing Address - Fax:480-946-0082
Practice Address - Street 1:2620 NORTH 68TH STREET
Practice Address - Street 2:MAIN BUILDING
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85257-1202
Practice Address - Country:US
Practice Address - Phone:480-946-6571
Practice Address - Fax:480-946-0082
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-17
Last Update Date:2013-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZALC-52593104A0630X
AZNCI-068314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No3104A0630XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Behavioral Disturbances
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ426355Medicaid
AZ035217Medicare Oscar/Certification
AZ426355Medicaid