Provider Demographics
NPI:1265832299
Name:EXTENDED CARE PORTFOLIO MULTISTATE POOL TENANT LLC
Entity Type:Organization
Organization Name:EXTENDED CARE PORTFOLIO MULTISTATE POOL TENANT LLC
Other - Org Name:PACIFICA SENIOR LIVING PARADISE VALLEY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:DEEPAK
Authorized Official - Middle Name:
Authorized Official - Last Name:ISRANI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-296-9000
Mailing Address - Street 1:1775 HANCOCK ST
Mailing Address - Street 2:200
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92110-2034
Mailing Address - Country:US
Mailing Address - Phone:619-296-9000
Mailing Address - Fax:619-296-9090
Practice Address - Street 1:16621 N 38TH ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-2102
Practice Address - Country:US
Practice Address - Phone:602-787-0800
Practice Address - Fax:602-787-0531
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-27
Last Update Date:2014-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAL6981C311500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311500000XNursing & Custodial Care FacilitiesAlzheimer Center (Dementia Center)