Provider Demographics
NPI:1639265382
Name:ASSISTED LIVING AT THE PHOENICIAN, INC.
Entity Type:Organization
Organization Name:ASSISTED LIVING AT THE PHOENICIAN, INC.
Other - Org Name:PHOENICIAN CARE HOME
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROXAS
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:602-524-8124
Mailing Address - Street 1:6501 E GREENWAY PKWY
Mailing Address - Street 2:SUITE 103, PMB 505
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-2065
Mailing Address - Country:US
Mailing Address - Phone:602-441-2563
Mailing Address - Fax:602-354-7129
Practice Address - Street 1:8649 W GREENBRIAN DR
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85382-0858
Practice Address - Country:US
Practice Address - Phone:602-441-2563
Practice Address - Fax:602-354-7129
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZALH-4828310400000X, 3104A0625X, 3104A0630X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Not Answered3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness
Not Answered3104A0630XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Behavioral Disturbances