Provider Demographics
NPI:1154669448
Name:ASSISTED LIVING AT BLOOMFIELD MANOR INC.
Entity Type:Organization
Organization Name:ASSISTED LIVING AT BLOOMFIELD MANOR INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:ZANELY
Authorized Official - Middle Name:ROXAS
Authorized Official - Last Name:ZARAGOZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-922-3299
Mailing Address - Street 1:6501 E GREENWAY PKWY
Mailing Address - Street 2:103-505
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-2065
Mailing Address - Country:US
Mailing Address - Phone:480-580-1650
Mailing Address - Fax:480-607-5444
Practice Address - Street 1:5815 E AIRE LIBRE AVE
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85254-9221
Practice Address - Country:US
Practice Address - Phone:480-922-3299
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-22
Last Update Date:2013-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAL4808H310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility