Provider Demographics
NPI:1508395757
Name:CSL-CHANDLER, LLC
Entity Type:Organization
Organization Name:CSL-CHANDLER, LLC
Other - Org Name:PENNINGTON GARDENS ASSISTED LIVING & MEMORY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REGIONAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CANDIS
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-605-8841
Mailing Address - Street 1:1580 VALLEY RIVER DR STE 260
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-2193
Mailing Address - Country:US
Mailing Address - Phone:541-636-3460
Mailing Address - Fax:541-636-3797
Practice Address - Street 1:977 S PENNINGTON DR
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-5658
Practice Address - Country:US
Practice Address - Phone:480-814-9046
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-09
Last Update Date:2017-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility