Provider Demographics
NPI:1740751320
Name:MARIPOSA PHOENIX AL PARTNERS, LP
Entity Type:Organization
Organization Name:MARIPOSA PHOENIX AL PARTNERS, LP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER OF ITS GENERAL PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSH
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-619-5372
Mailing Address - Street 1:6370 LBJ FREEWAY
Mailing Address - Street 2:SUITE 276
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75240
Mailing Address - Country:US
Mailing Address - Phone:469-619-5372
Mailing Address - Fax:
Practice Address - Street 1:3100 N 91ST AVENUE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85037
Practice Address - Country:US
Practice Address - Phone:623-934-4411
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-08
Last Update Date:2018-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAL10795CMedicaid