=====================================================
General NPI Number Information
=====================================================
NPI Number | 1891150173
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ABERDEEN HOME LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/30/2015
-----------------------------------------------------
Last Update Date | 12/30/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10639 N ABERDEEN RD
-----------------------------------------------------
City | SCOTTSDALE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85254-4849
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-659-2973
-----------------------------------------------------
Fax | 480-659-2573
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 26642 N 47TH PL
-----------------------------------------------------
City | CAVE CREEK
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85331-2600
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 602-625-5808
-----------------------------------------------------
Fax | 480-664-9171
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER
-----------------------------------------------------
Name | MARK LAWRENCE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 602-625-5808
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 310400000X
-----------------------------------------------------
Taxonomy Name | Assisted Living Facility
-----------------------------------------------------
License Number | AL9929H
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------