Provider Demographics
NPI:1760814727
Name:EXTENDED CARE PORTFOLIO MULTISTATE POOL TENANT, LLC
Entity Type:Organization
Organization Name:EXTENDED CARE PORTFOLIO MULTISTATE POOL TENANT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EX VP/CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHOEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-905-3347
Mailing Address - Street 1:1785 HANCOCK ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92110-2073
Mailing Address - Country:US
Mailing Address - Phone:619-296-9000
Mailing Address - Fax:
Practice Address - Street 1:2675 N WYATT DR
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-6107
Practice Address - Country:US
Practice Address - Phone:520-320-7505
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EXTENDED CARE PORTFOLIO TENANT, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-08-01
Last Update Date:2013-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAL6987C311500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311500000XNursing & Custodial Care FacilitiesAlzheimer Center (Dementia Center)