Provider Demographics
NPI:1437848165
Name:PLCC MANAGEMENT CO LLC
Entity Type:Organization
Organization Name:PLCC MANAGEMENT CO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KERRI
Authorized Official - Middle Name:
Authorized Official - Last Name:MASENGALE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-693-3109
Mailing Address - Street 1:PO BOX 4456
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85261-4456
Mailing Address - Country:US
Mailing Address - Phone:602-693-3109
Mailing Address - Fax:
Practice Address - Street 1:8777 E VIA DE VENTURA STE 399
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-3344
Practice Address - Country:US
Practice Address - Phone:602-693-3109
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-08
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility