=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396495263
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SENIOR VALLEY ASSISTED LIVING II LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/24/2022
-----------------------------------------------------
Last Update Date | 03/24/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 16810 N 66TH ST
-----------------------------------------------------
City | SCOTTSDALE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85254-5625
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 503-716-2033
-----------------------------------------------------
Fax | 480-699-1105
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 16810 N 66TH ST
-----------------------------------------------------
City | SCOTTSDALE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85254-5625
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 503-716-2033
-----------------------------------------------------
Fax | 480-699-1105
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/MANAGER
-----------------------------------------------------
Name | DENISA GHIURAU
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 503-716-2033
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 310400000X
-----------------------------------------------------
Taxonomy Name | Assisted Living Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------