Provider Demographics
NPI:1235334541
Name:CC/PDR-SCOTTSDALE, L.L.C.
Entity Type:Organization
Organization Name:CC/PDR-SCOTTSDALE, L.L.C.
Other - Org Name:VI AT GRAYHAWK, 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 1:7501 E THOMPSON PEAK PKWY
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85255-4525
Mailing Address - Country:US
Mailing Address - Phone:480-361-3200
Mailing Address - Fax:480-659-5110
Practice Address - Street 1:7501 E THOMPSON PEAK PKWY
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85255-4525
Practice Address - Country:US
Practice Address - Phone:480-361-3200
Practice Address - Fax:480-659-5110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-18
Last Update Date:2019-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZNCI-2616314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ035272Medicare Oscar/Certification