MEDICARE: BURKESHIRE RETIREMENT HOTEL, INC.

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
1	310400000X	Assisted Living Facility	ALC-4705	AZ

General Provider Information

NPI Number	:	1316149982
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BURKESHIRE RETIREMENT HOTEL, INC.

Provider Business Mailing Address
First Line	:	1310 E MCDOWELL RD
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85006-2616
Country	:	US
Telephone Number	:	623-977-4273
Fax Number	:	623-977-4322

Provider Business Practice Location Address
First Line	:	1310 E MCDOWELL RD
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85006-2616
Country	:	US
Telephone Number	:	623-977-4273
Fax Number	:	623-977-4322

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MRS. CONNIE M. SALERNO
Credential	:	LPN-CERTIFIED MANAGE
Telephone Number	:	623-977-4273

Provider Enumeration Date	:	06/05/2007
Last Update Date	:	08/22/2020

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