Provider Demographics
NPI:1740277136
Name:CASA DE CAPRI ENTERPRISES
Entity type:Organization
Organization Name:CASA DE CAPRI ENTERPRISES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DON
Authorized Official - Middle Name:
Authorized Official - Last Name:PIERCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-944-1574
Mailing Address - Street 1:1501 E ORANGEWOOD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85020-5199
Mailing Address - Country:US
Mailing Address - Phone:602-944-1574
Mailing Address - Fax:602-626-8549
Practice Address - Street 1:1501 E ORANGEWOOD AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85020-5130
Practice Address - Country:US
Practice Address - Phone:602-944-1574
Practice Address - Fax:602-626-8549
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-30
Last Update Date:2010-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZNCI-272314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ040220Medicaid
AZ035160Medicare Oscar/Certification