Provider Demographics
NPI:1720703739
Name:SILVER AGE RESIDENTIAL CARE
Entity Type:Organization
Organization Name:SILVER AGE RESIDENTIAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:CRISTNA
Authorized Official - Middle Name:
Authorized Official - Last Name:RADU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:224-489-8620
Mailing Address - Street 1:5019 W PARADISE LN # 5019
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85306-2655
Mailing Address - Country:US
Mailing Address - Phone:224-489-8620
Mailing Address - Fax:
Practice Address - Street 1:5019 W PARADISE LN # 5019
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85306-2655
Practice Address - Country:US
Practice Address - Phone:224-489-8620
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-11
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0630XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Behavioral Disturbances