Healthcare Provider Details

I. General information

NPI: 1376777359
Provider Name (Legal Business Name): LSREF GOLDEN OPS 26 (AZ), LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2009
Last Update Date: 05/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1475 S 46TH AVE
YUMA AZ
85364-4010
US

IV. Provider business mailing address

500 STEVENS AVE SUITE 100
SOLANA BEACH CA
92075-2055
US

V. Phone/Fax

Practice location:
  • Phone: 928-329-7707
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License NumberALC-6937
License Number StateAZ

VIII. Authorized Official

Name: MARC LIPSHY
Title or Position: PRESIDENT
Credential:
Phone: 858-436-7662