Healthcare Provider Details

I. General information

NPI: 1114273778
Provider Name (Legal Business Name): PLAZA HC HOLDING COMPANY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2012
Last Update Date: 04/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1475 N GRANITE REEF RD
SCOTTSDALE AZ
85257-3919
US

IV. Provider business mailing address

1475 N GRANITE REEF RD
SCOTTSDALE AZ
85257-3919
US

V. Phone/Fax

Practice location:
  • Phone: 480-990-1904
  • Fax: 480-946-6286
Mailing address:
  • Phone: 480-990-1904
  • Fax: 480-946-6286

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberNCI2661
License Number StateAZ

VIII. Authorized Official

Name: MICHAEL R SCHWARTZ
Title or Position: AGENT
Credential:
Phone: 818-905-8000