Provider Demographics
NPI:1467949156
Name:SOLTERRA 3RD INDIAN SCHOOL OPERATIONS, LLC
Entity Type:Organization
Organization Name:SOLTERRA 3RD INDIAN SCHOOL OPERATIONS, LLC
Other - Org Name:BRIDGEWATER ASSISTED LIVING - MIDTOWN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT OF FINANCE
Authorized Official - Prefix:MRS
Authorized Official - First Name:INGE
Authorized Official - Middle Name:G
Authorized Official - Last Name:DURAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-544-3195
Mailing Address - Street 1:14650 N 78TH WAY, BLDG B
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260
Mailing Address - Country:US
Mailing Address - Phone:602-544-3195
Mailing Address - Fax:602-533-7574
Practice Address - Street 1:4000 N 3RD AVENUE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85013
Practice Address - Country:US
Practice Address - Phone:480-653-9500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-18
Last Update Date:2018-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAL10641C310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAL10641COtherAZ DEPT HEALTH SVCS
AZ367767Medicaid