Organization
THE LODGE AT 14TH ST.
Active
Organization
THE LODGE AT 14TH ST.
Active
Other names
crystal lodge investors
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN GARVEY (GENERAL PARTNER)
(602) 279-1033
Entity
Organization
Contact information
Practice address
2941 N 14TH ST, PHOENIX, AZ 85014-5604
(602) 279-1033
(602) 277-5604
Mailing address
2941 N. 14TH ST., PHOENIX, AZ 85014-5604
(602) 279-1033
(602) 277-5367
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
ALC 4746
AZ
282J00000X
Religious Nonmedical Health Care Institution
ALC-4746
AZ
310400000X
Assisted Living Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
629-256
—
AZ
05
—
629256
—
AZ
Enumeration date
11/30/2005
Last updated
10/23/2024
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