Provider Demographics
NPI:1437573276
Name:WINDSOR AUSTIN HOUSE, LLC
Entity Type:Organization
Organization Name:WINDSOR AUSTIN HOUSE, LLC
Other - Org Name:AUSTIN HOUSE ASSISTED LIVING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINSTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:
Authorized Official - Last Name:GREENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-860-2270
Mailing Address - Street 1:9200 W SUNSET BLVD
Mailing Address - Street 2:7TH FLOOR
Mailing Address - City:WEST HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90069-3502
Mailing Address - Country:US
Mailing Address - Phone:310-860-2270
Mailing Address - Fax:
Practice Address - Street 1:195 S WILLARD ST
Practice Address - Street 2:
Practice Address - City:COTTONWOOD
Practice Address - State:AZ
Practice Address - Zip Code:86326-4123
Practice Address - Country:US
Practice Address - Phone:928-634-4278
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-14
Last Update Date:2014-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility