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NPI Code Detail

MEDICARE: SUNCREST HEALTHCARE CENTER, LLC

MEDICARE: SUNCREST HEALTHCARE CENTER, LLC
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
1314000000XSkilled Nursing FacilityNCI050AZ

Other Identifiers

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

General Provider Information

NPI Number : 1578526927
Entity Type Code : Organization
Provider Name (Legal Business Name) : SUNCREST HEALTHCARE CENTER, LLC
Provider Business Mailing Address
First Line : 2211 E SOUTHERN AVE
Second Line :
City : PHOENIX
State : AZ
Zip : 85040-3408
Country : US
Telephone Number : 602-305-7134
Fax Number : 602-305-8862
Provider Business Practice Location Address
First Line : 2211 E SOUTHERN AVE
Second Line :
City : PHOENIX
State : AZ
Zip : 85040-3408
Country : US
Telephone Number : 602-305-7134
Fax Number : 602-305-8862
Authorized Official
Title or Position : PRESIDENT
Name : MICHELLE ZIMBELMAN
Credential :
Telephone Number : 816-232-9573
Provider Enumeration Date : 04/07/2006
Last Update Date : 04/09/2013

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