Healthcare Provider Details

I. General information

NPI: 1932479946
Provider Name (Legal Business Name): CHANDLER FAIRVIEW PARTNERS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2012
Last Update Date: 12/05/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 WEST FAIRVIEW ST.
CHANDLER AZ
85224
US

IV. Provider business mailing address

111 MARKET ST NE STE 200
OLYMPIA WA
98501
US

V. Phone/Fax

Practice location:
  • Phone: 480-634-4191
  • Fax:
Mailing address:
  • Phone: 360-867-1900
  • Fax: 360-867-1956

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code311500000X
TaxonomyAlzheimer Center (Dementia Center)
License NumberAL8609C
License Number StateAZ

VIII. Authorized Official

Name: MR. EMMETT AARON KOELSCH
Title or Position: OWNER
Credential:
Phone: 360-867-1900