Organization
LAKESHORE CREST,LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARIAFE SANTOS CASTRO (MANAGER)
(480) 518-1969
Entity
Organization
Contact information
Practice address
19535 N 55TH DR, GLENDALE, AZ 85308-6805
(623) 376-6469
Mailing address
19535 N 55TH DR, GLENDALE, AZ 85308-6805
(623) 376-6469
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
AL8496H
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
629718
—
AZ
Enumeration date
06/27/2011
Last updated
03/12/2012
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