MEDICARE: EXTENDED CARE PORTFOLIO MULTISTATE POOL TENANT, 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
1	310400000X	Assisted Living Facility	UT000249	UT
2	310400000X	Assisted Living Facility	UT207219	UT

General Provider Information

NPI Number	:	1801295894
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EXTENDED CARE PORTFOLIO MULTISTATE POOL TENANT, LLC

Provider Business Mailing Address
First Line	:	1775 HANCOCK ST STE 200
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92110-2036
Country	:	US
Telephone Number	:	619-296-9000
Fax Number	:	619-296-9090

Provider Business Practice Location Address
First Line	:	777 E 3900 S
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84107-2199
Country	:	US
Telephone Number	:	801-288-0700
Fax Number	:	801-288-2777

Authorized Official
Title or Position	:	MANAGER
Name	:	MR. DEEPAK ISRANI
Credential	:
Telephone Number	:	619-296-9000

Provider Enumeration Date	:	08/15/2014
Last Update Date	:	08/15/2014

Similar Medicare Providers

1033317078 — ENCORE SENIOR LIVING II, LLC
Practice Location Address:

777 E 3900 S
SALT LAKE CITY, UT
84107-2199

Practice Phone: 801-288-0700
Practice Fax: 801-288-2777

1235327875 — ENCORE SENIOR LIVING, LLC
Practice Location Address:

777 E 3900 S
SALT LAKE CITY, UT
84107-2199

Practice Phone: 801-288-0700
Practice Fax:

1932805884 — ASHLEY K RUDD
Practice Location Address:

777 E 3900 S
SALT LAKE CITY, UT
84107-2199

Practice Phone: 385-743-8360
Practice Fax:

1790669620 — STONPATH COUNSELING NETWORK
Practice Location Address:

2199 S LAKE ST APT 7
SALT LAKE CITY, UT
84106-5801

Practice Phone: 801-884-6531
Practice Fax:

1619608189 — ADILVANIA F DA COSTA RESTA
Practice Location Address:

777 E 3900 S
MILLCREEK, UT
84107-2199

Practice Phone: 954-773-1050
Practice Fax:

1518938398 — MS. MELISSA JOY ROBERTS JD, MSN, FNP-BC
Practice Location Address:

9709 N VIRGINIA AVE
KANSAS CITY, MO
64155-2199

Practice Phone: 816-734-1340
Practice Fax:

Directions to “EXTENDED CARE PORTFOLIO MULTISTATE POOL TENANT, LLC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.