NPIMap

Organization Active NPI

Providence Manoir Assisted Living

  • Assisted Living Facility
  • Chandler, AZ
National Provider Identifier
1285837872
Registry record updated Nov 5, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Assisted Living FacilityTaxonomy code 310400000X
License
ALH-5829 Issued in AZ
Legal business name
PROVIDENCE MANOIR ASSISTED LIVING
Practice address
6567 S Garnet Way
Chandler, AZ 85249-7255
Phone
(480) 388-1140
Fax
(480) 219-1889
NPI assigned
Jun 9, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 5, 2007

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

Authorized official

Name
Mr. Jean-Marie Charles
Title
Director of Admissions
Phone
(480) 388-1140

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Assisted Living Facility 310400000X ALH-5829 AZ Primary

Addresses

Primary practice location

6567 S Garnet Way
Chandler, AZ 85249-7255

Mailing address

6567 S Garnet Way
Chandler, AZ 85249-7255
Phone (480) 388-1140

Other identifiers 1

IdentifierTypeStateIssuer
162761OtherAZALTCS PROVIDER

National Provider Directory

National Provider Directory
Tax ID family
Providence Legacy Assisted Living2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

NPI Registry JSON

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

{
    "created_epoch": "1181347200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1194220800000",
    "number": "1285837872",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6567 S GARNET WAY",
            "city": "CHANDLER",
            "state": "AZ",
            "postal_code": "852497255",
            "telephone_number": "480-388-1140",
            "fax_number": "480-219-1889"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6567 S GARNET WAY",
            "city": "CHANDLER",
            "state": "AZ",
            "postal_code": "852497255",
            "telephone_number": "480-388-1140",
            "fax_number": "480-219-1889"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENCE MANOIR ASSISTED LIVING",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-09",
        "last_updated": "2007-11-05",
        "status": "A",
        "authorized_official_last_name": "CHARLES",
        "authorized_official_first_name": "JEAN-MARIE",
        "authorized_official_title_or_position": "DIRECTOR OF ADMISSIONS",
        "authorized_official_telephone_number": "480-388-1140",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "AZ",
            "license": "ALH-5829",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ALTCS PROVIDER",
            "identifier": "162761",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Chandler, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 5, 2007; 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.