Pennington Gardens SL, LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

PENNINGTON GARDENS SL, LLC

Doing business as

Pennington Gardens

Practice address

977 S Pennington Dr
Chandler, AZ 85224-5658

Phone

(480) 814-9046

Fax

(480) 814-9058

NPI assigned

Mar 22, 2022

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Steven Bae

Title

VP of Org Development

Phone

(503) 675-3925

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Pennington Gardens Doing business as

Electronic endpoints 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1647907200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1692835200000",
    "number": "1073262333",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "560 1ST ST STE 104",
            "city": "LAKE OSWEGO",
            "state": "OR",
            "postal_code": "970343273",
            "telephone_number": "503-675-3925"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "977 S PENNINGTON DR",
            "city": "CHANDLER",
            "state": "AZ",
            "postal_code": "852245658",
            "telephone_number": "480-814-9046",
            "fax_number": "480-814-9058"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PENNINGTON GARDENS SL, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-03-22",
        "last_updated": "2023-08-24",
        "certification_date": "2023-08-24",
        "status": "A",
        "authorized_official_last_name": "BAE",
        "authorized_official_first_name": "STEVEN",
        "authorized_official_title_or_position": "VP OF ORG DEVELOPMENT",
        "authorized_official_telephone_number": "503-675-3925"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "295255",
            "state": "AZ"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "QMAR",
            "affiliation": "N",
            "endpointDescription": "EMAR System",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "977 S Pennington Dr",
            "city": "Chandler",
            "state": "AZ",
            "country_code": "US",
            "postal_code": "852245658",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Pennington Gardens",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Assisted Living Facility in Chandler, AZ
• Providers in Chandler, AZ by specialty
• Assisted Living Facility in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 24, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.