Provider Demographics
NPI:1265634174
Name:ELDER CARE GERIATRIC SERVICES
Entity Type:Organization
Organization Name:ELDER CARE GERIATRIC SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ERNA
Authorized Official - Middle Name:H
Authorized Official - Last Name:ARNOLD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-969-1197
Mailing Address - Street 1:1 N MACDONALD
Mailing Address - Street 2:SUITE 13
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85201-7339
Mailing Address - Country:US
Mailing Address - Phone:480-969-1197
Mailing Address - Fax:480-835-8809
Practice Address - Street 1:1 N MACDONALD
Practice Address - Street 2:SUITE 13
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85201-7339
Practice Address - Country:US
Practice Address - Phone:480-969-1197
Practice Address - Fax:480-835-8809
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ779944OtherARIZONA AHCCESS