Provider Demographics
NPI:1972081420
Name:MESA CT AL MC CARE PROPERTIES, LLC
Entity Type:Organization
Organization Name:MESA CT AL MC CARE PROPERTIES, LLC
Other - Org Name:COURTYARD TOWERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:RODERICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-443-1818
Mailing Address - Street 1:7420 SW BRIDGEPORT RD STE 105
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97224-7790
Mailing Address - Country:US
Mailing Address - Phone:503-597-4906
Mailing Address - Fax:503-924-6169
Practice Address - Street 1:22 N ROBSON
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85201-7330
Practice Address - Country:US
Practice Address - Phone:480-649-3000
Practice Address - Fax:480-898-7034
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-06
Last Update Date:2018-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAL9746C310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility