Provider Demographics
NPI:1376616235
Name:PECOS HEALTH CARE LIMITED PTRSHP
Entity Type:Organization
Organization Name:PECOS HEALTH CARE LIMITED PTRSHP
Other - Org Name:ARCHSTONE CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ALLEN
Authorized Official - Middle Name:R
Authorized Official - Last Name:DUNLAP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-821-1268
Mailing Address - Street 1:1980 W PECOS RD
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-5606
Mailing Address - Country:US
Mailing Address - Phone:480-821-1268
Mailing Address - Fax:480-782-1073
Practice Address - Street 1:1980 W PECOS RD
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-5606
Practice Address - Country:US
Practice Address - Phone:480-821-1268
Practice Address - Fax:480-782-1073
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-16
Last Update Date:2016-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZNCI-390314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ382713Medicaid
AZ382713Medicaid