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General NPI Number Information
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NPI Number | 1770849648
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Entity Type | Organization
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Legal Business Name | DES MOINES SPECIALIZED CARE
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Dates
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Enumeration Date | 04/05/2012
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Last Update Date | 04/05/2012
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Provider Practice Location Address
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Address Line | 15029 N THOMPSON PEAK PKWY SUITE B-111, #418
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City | SCOTTSDALE
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State | AZ
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Zip | 85260-2217
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Country | US
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Telephone | 602-793-6265
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Fax | 480-621-5842
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Provider Business Mailing Address
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Address Line | 15029 N. THOMPSON PEAK PKWAY SUITE B-111, #418
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City | SCOTTSDALE
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State | AZ
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Zip | 85260
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Country | US
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Telephone | 602-793-6265
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Fax | 480-621-5842
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Authorized Official
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Title or Position | OWNER
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Name | LUCIAN SAUCAN
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Credential |
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Telephone | 602-793-6265
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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 | 136599
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License Number State | AZ
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