Healthcare Provider Details

I. General information

NPI: 1639481138
Provider Name (Legal Business Name): SCOTTSDALE HEALTHCARE CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2010
Last Update Date: 02/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10250 N 92ND ST SUITE 304
SCOTTSDALE AZ
85258-4510
US

IV. Provider business mailing address

POX 845635
LOS ANGELES CA
90084-5635
US

V. Phone/Fax

Practice location:
  • Phone: 480-451-7676
  • Fax: 480-451-0971
Mailing address:
  • Phone: 623-434-6200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MR. RICHARD SILVER
Title or Position: CEO
Credential:
Phone: 623-434-6200