Provider Demographics
NPI:1568665180
Name:PLATINUM ASSISTED CARE
Entity Type:Organization
Organization Name:PLATINUM ASSISTED CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DENEEN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:DE VRIES
Authorized Official - Suffix:
Authorized Official - Credentials:PT, MBA
Authorized Official - Phone:623-221-1544
Mailing Address - Street 1:7041 W WILLOW AVE
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381-5084
Mailing Address - Country:US
Mailing Address - Phone:623-221-1544
Mailing Address - Fax:623-334-3289
Practice Address - Street 1:3503 E FOUNTAIN CIR
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85213-5510
Practice Address - Country:US
Practice Address - Phone:623-221-1544
Practice Address - Fax:623-334-3289
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZALH-5480310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility