Provider Demographics
NPI:1669467098
Name:WESTMINSTER VILLAGE INC
Entity Type:Organization
Organization Name:WESTMINSTER VILLAGE INC
Other - Org Name:WEYRICH HEALTH CARE CENTER AT WESTMINSTER VILLAGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BOARD PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:C
Authorized Official - Last Name:FREDERIKSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-585-5987
Mailing Address - Street 1:12000 N 90TH STREET
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260
Mailing Address - Country:US
Mailing Address - Phone:480-451-2000
Mailing Address - Fax:480-451-2470
Practice Address - Street 1:12000 N 90TH STREET
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260
Practice Address - Country:US
Practice Address - Phone:480-451-2000
Practice Address - Fax:480-451-2470
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-12
Last Update Date:2007-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZNCI411314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
035192Medicare ID - Type Unspecified