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NPI Code Detail

MEDICARE: GLENDALE HEALTHCARE ASSOCIATES LLC

MEDICARE: GLENDALE HEALTHCARE ASSOCIATES 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 FacilityAZ

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 : 1174518013
Entity Type Code : Organization
Provider Name (Legal Business Name) : GLENDALE HEALTHCARE ASSOCIATES LLC
Provider Business Mailing Address
First Line : 5125 N 58TH AVE
Second Line :
City : GLENDALE
State : AZ
Zip : 85301-7453
Country : US
Telephone Number : 623-931-5800
Fax Number : 623-931-8776
Provider Business Practice Location Address
First Line : 5125 N 58TH AVE
Second Line :
City : GLENDALE
State : AZ
Zip : 85301-7453
Country : US
Telephone Number : 623-931-5800
Fax Number : 623-931-8776
Authorized Official
Title or Position : TREASURER
Name : MS. SOON BURNAM
Credential :
Telephone Number : 949-540-1249
Provider Enumeration Date : 09/16/2005
Last Update Date : 07/21/2022

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5125 N 58TH AVE
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1912230061 — THOMAS DAVID RITER COTA
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85301-7453
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1033444633 — GLENDALE HEALTHCARE ASSOC., LLC
Practice Location Address:
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1841526597 — MRS. STEPHANIE RUTH PATTERSON PTA
Practice Location Address:
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85301-7453
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Practice Fax: 623-931-8776

Directions to “GLENDALE HEALTHCARE ASSOCIATES LLC ” Practice Location

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