Provider Demographics
NPI:1225052814
Name:PHOENIX JEWISH COMMUNITY KIVEL NURSING HOME
Entity Type:Organization
Organization Name:PHOENIX JEWISH COMMUNITY KIVEL NURSING HOME
Other - Org Name:PHOENIX JEWISH COMMUNITY KIVEL NURSING HOME
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:IRA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHULMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-443-8020
Mailing Address - Street 1:3040 N 36TH ST
Mailing Address - Street 2:KIVEL MANOR ASSISTED LIVING
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018
Mailing Address - Country:US
Mailing Address - Phone:602-443-8020
Mailing Address - Fax:602-957-9493
Practice Address - Street 1:3040 N 36TH ST
Practice Address - Street 2:KIVEL MANOR ASSISTED LIVING
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85018
Practice Address - Country:US
Practice Address - Phone:602-443-8020
Practice Address - Fax:602-957-9493
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-27
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZALC-5831310400000X
AZNCI-164314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Not Answered314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ121592Medicaid
AZ035161Medicare ID - Type UnspecifiedMEDICARE NUMBER