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
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Contact us