Organization
ILHC OF PHOENIX, LLC
Active
Other names
ARIZONA GRAND SENIOR LIVING COMMUNITY
Organization subpart
No
Provider details
NPI number
Authorized official
ELAINE R. BURTON (PRESIDENT & CHAIR OF BD OF MANAGERS)
(952) 361-8000
Entity
Organization
Contact information
Practice address
4602 N 24TH ST, PHOENIX, AZ 85016-5253
(602) 954-9178
(602) 553-8344
Mailing address
1107 HAZELTINE BLVD, SUITE 200, CHASKA, MN 55318-1009
(952) 361-8000
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
ALC-5695
AZ
314000000X
Skilled Nursing Facility
Primary
NCI-2656
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
AZ0914230
BCBS OF ARIZONA
—
Enumeration date
11/01/2006
Last updated
12/08/2014
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