Provider Demographics
NPI:1386635134
Name:TEMPE LIFE CARE VILLAGE INC
Entity Type:Organization
Organization Name:TEMPE LIFE CARE VILLAGE INC
Other - Org Name:FRIENDSHIP VILLAGE OF TEMPE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:J
Authorized Official - Last Name:CASSANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-560-3688
Mailing Address - Street 1:2645 E SOUTHERN AVE
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-7649
Mailing Address - Country:US
Mailing Address - Phone:480-831-0880
Mailing Address - Fax:480-831-3259
Practice Address - Street 1:2525 E SOUTHERN AVE
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-7741
Practice Address - Country:US
Practice Address - Phone:480-831-3184
Practice Address - Fax:480-831-3259
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-01
Last Update Date:2017-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZALC4366310400000X
AZALC4711311500000X
AZNCI2646314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No311500000XNursing & Custodial Care FacilitiesAlzheimer Center (Dementia Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ035074Medicare Oscar/Certification