MEDICARE: SCOTTSDALE RESIDENTIAL CARE INVESTORS

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	3104A0630X	Assisted Living Facility (Behavioral Disturbances)	ALC-5259	AZ
2	314000000X	Skilled Nursing Facility	NCI-068	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1144212093
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SCOTTSDALE RESIDENTIAL CARE INVESTORS

Provider Business Mailing Address
First Line	:	2620 N 68TH ST
Second Line	:
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85257-1202
Country	:	US
Telephone Number	:	480-946-6571
Fax Number	:	480-946-0082

Provider Business Practice Location Address
First Line	:	2620 NORTH 68TH STREET
Second Line	:	MAIN BUILDING
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85257-1202
Country	:	US
Telephone Number	:	480-946-6571
Fax Number	:	480-946-0082

Authorized Official
Title or Position	:	CONTROLLER
Name	:	MRS. BARBARA A. BYRUM
Credential	:
Telephone Number	:	480-946-6571

Provider Enumeration Date	:	08/17/2005
Last Update Date	:	07/24/2013

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