Provider Demographics
NPI:1477603363
Name:LA LOMA SENIOR LIVING SERVICES, INC.
Entity Type:Organization
Organization Name:LA LOMA SENIOR LIVING SERVICES, INC.
Other - Org Name:LA LOMA CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:A
Authorized Official - Last Name:GRAMBOW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-832-4335
Mailing Address - Street 1:14260 DENNY BLVD
Mailing Address - Street 2:
Mailing Address - City:LITCHFIELD PARK
Mailing Address - State:AZ
Mailing Address - Zip Code:85340-9448
Mailing Address - Country:US
Mailing Address - Phone:623-537-7400
Mailing Address - Fax:623-537-7480
Practice Address - Street 1:14260 DENNY BLVD
Practice Address - Street 2:
Practice Address - City:LITCHFIELD PARK
Practice Address - State:AZ
Practice Address - Zip Code:85340-9448
Practice Address - Country:US
Practice Address - Phone:623-537-7400
Practice Address - Fax:623-537-7480
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2016-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZNCI-2654314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ0440830OtherBCBS OF AZ PROVIDER NUMBE
AZ0440830OtherBCBS OF AZ PROVIDER NUMBE
AZ035264Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER