MEDICARE: CC PDR SILVERSTONE L L C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility	NCI-2695	AZ

General Provider Information

NPI Number	:	1093019770
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CC PDR SILVERSTONE L L C

Provider Business Mailing Address
First Line	:	233 S WACKER DR STE 8400
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60606-6316
Country	:	US
Telephone Number	:	312-803-8800
Fax Number	:

Provider Business Practice Location Address
First Line	:	22605 N 74TH ST
Second Line	:
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85255-7466
Country	:	US
Telephone Number	:	480-478-6200
Fax Number	:	480-478-6297

Authorized Official
Title or Position	:	COUNSEL
Name	:	TOMEK J KOSZYLKO
Credential	:
Telephone Number	:	312-803-8443

Provider Enumeration Date	:	01/10/2011
Last Update Date	:	06/01/2026

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Directions to “CC PDR SILVERSTONE L L C ” Practice Location

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