Healthcare Provider Details

I. General information

NPI: 1235185836
Provider Name (Legal Business Name): FS TENANT POOL II TRUST
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 08/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7090 E MESCAL ST
SCOTTSDALE AZ
85254-6118
US

IV. Provider business mailing address

7100 E MESCAL ST
SCOTTSDALE AZ
85254-6126
US

V. Phone/Fax

Practice location:
  • Phone: 480-948-3990
  • Fax: 480-951-7389
Mailing address:
  • Phone: 480-948-3990
  • Fax: 480-951-7389

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License NumberN046033
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberNCI343
License Number StateAZ

VIII. Authorized Official

Name: KATHERINE E POTTER
Title or Position: PRESIDENT & CHIEF EXECUTIVE OFFICER
Credential:
Phone: 617-796-8387