=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225323033
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SCOTTSDALE ASSISED LIVING
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/09/2011
-----------------------------------------------------
Last Update Date | 06/09/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10635 E RISING SUN DR
-----------------------------------------------------
City | SCOTTSDALE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85262-3083
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-268-7726
-----------------------------------------------------
Fax | 480-361-8732
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10635 E RISING SUN DR
-----------------------------------------------------
City | SCOTTSDALE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85262-3083
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-268-7726
-----------------------------------------------------
Fax | 480-361-8732
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER
-----------------------------------------------------
Name | HELEN DIKE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 480-268-7726
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 310400000X
-----------------------------------------------------
Taxonomy Name | Assisted Living Facility
-----------------------------------------------------
License Number | AL788OH
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------