MEDICARE: ASSISTED LIVING AT THE PHOENICIAN 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	ALH-6225	AZ

General Provider Information

NPI Number	:	1639318199
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ASSISTED LIVING AT THE PHOENICIAN INC.

Provider Business Mailing Address
First Line	:	6501 E GREENWAY PKWY
Second Line	:	103-505
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85254-2065
Country	:	US
Telephone Number	:	480-580-1650
Fax Number	:	480-607-5444

Provider Business Practice Location Address
First Line	:	3437 W ACOMA DR
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85053-5620
Country	:	US
Telephone Number	:	480-580-1650
Fax Number	:	480-607-5444

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MARIA ROXAS
Credential	:
Telephone Number	:	480-580-1650

Provider Enumeration Date	:	02/06/2009
Last Update Date	:	02/06/2009

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