Provider Demographics
NPI:1770031502
Name:COLTEN ADULT CARE, LLC
Entity Type:Organization
Organization Name:COLTEN ADULT CARE, LLC
Other - Org Name:CASA BUENAVANTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:COLTEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-483-4747
Mailing Address - Street 1:13951 N SCOTTSDALE RD
Mailing Address - Street 2:SUITE #121
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-3452
Mailing Address - Country:US
Mailing Address - Phone:480-483-4747
Mailing Address - Fax:480-483-6845
Practice Address - Street 1:7741 E CHARTER OAK RD
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-4827
Practice Address - Country:US
Practice Address - Phone:480-483-4747
Practice Address - Fax:480-483-6845
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-21
Last Update Date:2016-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAL4812H310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility