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NPI Code Detail

MEDICARE: CC PDR SCOTTSDALE LLC

MEDICARE: CC PDR SCOTTSDALE 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
1310400000XAssisted Living Facility

General Provider Information

NPI Number : 1891255139
Entity Type Code : Organization
Provider Name (Legal Business Name) : CC PDR SCOTTSDALE LLC
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 : 7501 E THOMPSON PEAK PKWY
Second Line :
City : SCOTTSDALE
State : AZ
Zip : 85255-4525
Country : US
Telephone Number : 480-659-5100
Fax Number :
Authorized Official
Title or Position : COUNSEL
Name : TOMEK J KOSZYLKO
Credential :
Telephone Number : 312-803-8443
Provider Enumeration Date : 03/22/2019
Last Update Date : 06/01/2026

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Directions to “CC PDR SCOTTSDALE LLC ” Practice Location

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