Organization
19TH AVENUE OPERATIONS, LLC
Active
Other names
The Palazzo
Organization subpart
No
Provider details
NPI number
Authorized official
TRACY L. CLARK JR. (AUTHORIZED REPRESENTATIVE)
(310) 337-1929
Entity
Organization
Contact information
Practice address
6246 N 19TH AVE, PHOENIX, AZ 85015-1511
(602) 433-6300
(602) 433-6458
Mailing address
1000 CORPORATE POINTE, SUITE 100, CULVER CITY, CA 90230-7690
(310) 337-1929
(310) 861-1661
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
AL10013C
AZ
310400000X
Assisted Living Facility
AL10014C
AZ
314000000X
Skilled Nursing Facility
Primary
NCI-2694
AZ
Other
Enumeration date
05/20/2016
Last updated
01/04/2017
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