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Organization
19TH AVENUE OPERATIONS, LLC
Active
Organization
19TH AVENUE OPERATIONS, LLC
Active
Other names
The Palazzo
Organization subpart
No
Provider details
NPI number
Authorized official
TRACY L. CLARK JR. (AUTHORIZED REPRESENTATIVE)
(310) 337-1929
Entity
Organization
Contact information
Practice address
6246 N 19TH AVE, PHOENIX, AZ 85015-1511
(602) 433-6300
(602) 433-6458
Mailing address
1000 CORPORATE POINTE, SUITE 100, CULVER CITY, CA 90230-7690
(310) 337-1929
(310) 861-1661
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
AL10013C
AZ
310400000X
Assisted Living Facility
AL10014C
AZ
314000000X
Skilled Nursing Facility
Primary
NCI-2694
AZ
Other
Enumeration date
05/20/2016
Last updated
01/04/2017
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