Provider Demographics
NPI:1457077661
Name:TP DEER VALLEY OPERATIONS, LLC
Entity Type:Organization
Organization Name:TP DEER VALLEY OPERATIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:JORGENSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-315-7644
Mailing Address - Street 1:14650 N 78TH WAY
Mailing Address - Street 2:BLDG B
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260
Mailing Address - Country:US
Mailing Address - Phone:602-544-3195
Mailing Address - Fax:602-553-7574
Practice Address - Street 1:2641 W UNION HILLS DR.
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85027
Practice Address - Country:US
Practice Address - Phone:602-603-7480
Practice Address - Fax:602-603-7485
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-19
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility