NPIMap

Organization Active NPI

Welltower Tenant Group LLC

  • Assisted Living Facility
  • Lake Havasu City, AZ
National Provider Identifier
1093384133
Registry record updated Jun 23, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Assisted Living FacilityTaxonomy code 310400000X
Legal business name
WELLTOWER TENANT GROUP LLC
Practice address
320 Lake Havasu Ave N
Lake Havasu City, AZ 86403-4701
Phone
(928) 855-8099
Fax
(928) 855-6666
NPI assigned
Jun 23, 2021
Organization subpart
Yes
Parent organization
WELLTOWER TENANT GROUP LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 23, 2021

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

Authorized official

Name
Christmas J Brown
Title
Risk & Compliance
Phone
(503) 597-4906

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Assisted Living Facility 310400000X Primary

Addresses

Primary practice location

320 Lake Havasu Ave N
Lake Havasu City, AZ 86403-4701

Mailing address

7420 SW Bridgeport Rd Ste 105
Portland, OR 97224-7790
Phone (503) 597-4906

Other identifiers 1

IdentifierTypeStateIssuer
092050MedicaidAZ

Other names 1

  • Lake View Terrace Memory CAre Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Welltower Tenant Group LLC4 organizations share this tax ID, including this one
Part of
Welltower Tenant Group LLC

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Locations

320 Lake Havasu Ave N
Lake Havasu City, AZ 86403
Phone (928) 855-8099

NPI Registry JSON

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

{
    "created_epoch": "1624406400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1624406400000",
    "number": "1093384133",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7420 SW BRIDGEPORT RD STE 105",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972247790",
            "telephone_number": "503-597-4906"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "320 LAKE HAVASU AVE N",
            "city": "LAKE HAVASU CITY",
            "state": "AZ",
            "postal_code": "864034701",
            "telephone_number": "928-855-8099",
            "fax_number": "928-855-6666"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WELLTOWER TENANT GROUP LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WELLTOWER TENANT GROUP LLC",
        "enumeration_date": "2021-06-23",
        "last_updated": "2021-06-23",
        "certification_date": "2021-06-03",
        "status": "A",
        "authorized_official_last_name": "BROWN",
        "authorized_official_first_name": "CHRISTMAS",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "RISK & COMPLIANCE",
        "authorized_official_telephone_number": "503-597-4906"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "092050",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lake View Terrace Memory CAre",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lake Havasu City, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2021; 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.