Provider Demographics
NPI:1245420223
Name:ST. CHARLES PLACE, LLC
Entity Type:Organization
Organization Name:ST. CHARLES PLACE, LLC
Other - Org Name:ST CHARLES PLACE LLC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:W
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:602-276-0084
Mailing Address - Street 1:6818 S 16TH PL
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85042-5714
Mailing Address - Country:US
Mailing Address - Phone:602-276-0084
Mailing Address - Fax:602-276-0084
Practice Address - Street 1:6818 S 16TH PL
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85042-5714
Practice Address - Country:US
Practice Address - Phone:602-276-0084
Practice Address - Fax:602-276-0084
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST CHARLES PLACE LLC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-07-26
Last Update Date:2008-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZALH3031310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility