Provider Demographics
NPI:1528601960
Name:SILVER CREEK MANORS LLC
Entity Type:Organization
Organization Name:SILVER CREEK MANORS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LENORE
Authorized Official - Middle Name:
Authorized Official - Last Name:GAINES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-971-9626
Mailing Address - Street 1:4608 E CABALLERO ST APT 2
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85205-2764
Mailing Address - Country:US
Mailing Address - Phone:619-971-9626
Mailing Address - Fax:
Practice Address - Street 1:4608 E CABALLERO ST APT 2
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85205-2764
Practice Address - Country:US
Practice Address - Phone:619-971-9626
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-17
Last Update Date:2019-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities