# 19TH AVENUE OPERATIONS, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** The Palazzo
- **Organization subpart:** No

## Provider details

- **NPI number:** 1649627423
- **Authorized official:** TRACY L. CLARK JR. (AUTHORIZED REPRESENTATIVE)
- **Authorized official phone:** (310) 337-1929

## Contact information

- **Practice address:** 6246 N 19TH AVE, PHOENIX, AZ 85015-1511
- **Practice address phone:** (602) 433-6300
- **Practice address fax:** (602) 433-6458
- **Mailing address:** 1000 CORPORATE POINTE, SUITE 100, CULVER CITY, CA 90230-7690
- **Mailing address phone:** (310) 337-1929
- **Mailing address fax:** (310) 861-1661

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 310400000X | Assisted Living Facility | AL10013C | AZ | — |
| 310400000X | Assisted Living Facility | AL10014C | AZ | — |
| 314000000X | Skilled Nursing Facility | NCI-2694 | AZ | Yes |

## Other

- **Enumeration date:** 05/20/2016
- **Last updated:** 01/04/2017