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NPI Code Detail

MEDICARE: AZORE II, LLC

MEDICARE: AZORE II, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1314000000XSkilled Nursing FacilityNCI2661AZ

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1124064605
Entity Type Code : Organization
Provider Name (Legal Business Name) : AZORE II, LLC
Provider Business Mailing Address
First Line : 1077 GATEWAY LOOP
Second Line :
City : SPRINGFIELD
State : OR
Zip : 97477-1114
Country : US
Telephone Number : 541-746-1020
Fax Number : 541-284-7072
Provider Business Practice Location Address
First Line : 6246 N 19TH AVE
Second Line :
City : PHOENIX
State : AZ
Zip : 85015-1511
Country : US
Telephone Number : 602-433-6300
Fax Number : 602-433-6458
Authorized Official
Title or Position : CHIEF FINANCIAL OFFICER
Name : MR. MARK GARBER
Credential :
Telephone Number : 541-746-1020
Provider Enumeration Date : 06/21/2006
Last Update Date : 02/23/2015

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Directions to “AZORE II, LLC ” Practice Location

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