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General NPI Number Information
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NPI Number | 1386635134
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Entity Type | Organization
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Legal Business Name | TEMPE LIFE CARE VILLAGE INC
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Dates
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Enumeration Date | 11/01/2005
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Last Update Date | 02/06/2017
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Provider Practice Location Address
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Address Line | 2525 E SOUTHERN AVE
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City | TEMPE
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State | AZ
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Zip | 85282-7741
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Country | US
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Telephone | 480-831-3184
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Fax | 480-831-3259
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Provider Business Mailing Address
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Address Line | 2645 E SOUTHERN AVE
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City | TEMPE
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State | AZ
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Zip | 85282-7649
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Country | US
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Telephone | 480-831-0880
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Fax | 480-831-3259
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Authorized Official
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Title or Position | PRESIDENT
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Name | DONALD J CASSANO
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Credential |
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Telephone | 480-560-3688
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | ALC4366
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 311500000X
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Taxonomy Name | Alzheimer Center (Dementia Center)
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License Number | ALC4711
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License Number State | AZ
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Taxonomy #3
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | NCI2646
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License Number State | AZ
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