Provider Demographics
NPI:1225323033
Name:SCOTTSDALE ASSISED LIVING
Entity Type:Organization
Organization Name:SCOTTSDALE ASSISED LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:HELEN
Authorized Official - Middle Name:
Authorized Official - Last Name:DIKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-268-7726
Mailing Address - Street 1:10635 E RISING SUN DR
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85262-3083
Mailing Address - Country:US
Mailing Address - Phone:480-268-7726
Mailing Address - Fax:480-361-8732
Practice Address - Street 1:10635 E RISING SUN DR
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85262-3083
Practice Address - Country:US
Practice Address - Phone:480-268-7726
Practice Address - Fax:480-361-8732
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-09
Last Update Date:2011-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAL788OH310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ399397Medicaid