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Organization
ILHC OF PHOENIX, LLC
Active
Organization
ILHC OF PHOENIX, LLC
Active
Other names
ARIZONA GRAND SENIOR LIVING COMMUNITY
Organization subpart
No
Provider details
NPI number
Authorized official
ELAINE R. BURTON (PRESIDENT & CHAIR OF BD OF MANAGERS)
(952) 361-8000
Entity
Organization
Contact information
Practice address
4602 N 24TH ST, PHOENIX, AZ 85016-5253
(602) 954-9178
(602) 553-8344
Mailing address
1107 HAZELTINE BLVD, SUITE 200, CHASKA, MN 55318-1009
(952) 361-8000
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
ALC-5695
AZ
314000000X
Skilled Nursing Facility
Primary
NCI-2656
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
AZ0914230
BCBS OF ARIZONA
—
Enumeration date
11/01/2006
Last updated
12/08/2014
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