Provider Demographics
NPI:1508856089
Name:THE BEATITUDES CAMPUS
Entity Type:Organization
Organization Name:THE BEATITUDES CAMPUS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:MS
Authorized Official - First Name:CAMMY
Authorized Official - Middle Name:
Authorized Official - Last Name:CLEVENGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-995-2611
Mailing Address - Street 1:1616 W GLENDALE AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85021-8948
Mailing Address - Country:US
Mailing Address - Phone:602-995-2611
Mailing Address - Fax:602-995-6127
Practice Address - Street 1:1616 W GLENDALE AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85021-8948
Practice Address - Country:US
Practice Address - Phone:602-995-2611
Practice Address - Fax:602-995-6127
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-25
Last Update Date:2008-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZALC-4281310400000X
AZNCI-256314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ040163Medicaid
AZ0783780001Medicare NSC
AZ035176Medicare ID - Type Unspecified