Provider Demographics
NPI:1598466286
Name:NORTH CENTRAL SHORES LLC
Entity Type:Organization
Organization Name:NORTH CENTRAL SHORES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MANUELA
Authorized Official - Middle Name:
Authorized Official - Last Name:CALLINI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-297-5153
Mailing Address - Street 1:8825 N 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85021-0008
Mailing Address - Country:US
Mailing Address - Phone:602-341-6150
Mailing Address - Fax:602-675-4070
Practice Address - Street 1:8825 N 3RD AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85021-0008
Practice Address - Country:US
Practice Address - Phone:602-341-6150
Practice Address - Fax:602-675-4070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-10
Last Update Date:2023-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility