Organization
AHWATUKEE MC CARE PROPERTIES, LLC
Active
Other names
Hawthorn Court at Ahwatukee
Organization subpart
No
Provider details
NPI number
Authorized official
GREGORY A. RODERICK (MEMBER)
(503) 443-1818
Entity
Organization
Contact information
Practice address
13822 S 46TH PL, PHOENIX, AZ 85044-4844
(480) 598-1224
(480) 598-9407
Mailing address
7420 SW BRIDGEPORT RD STE 105, PORTLAND, OR 97224-7790
(503) 597-4906
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
594719
AHCCCS
AZ
Enumeration date
01/10/2020
Last updated
06/15/2021
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