The Harbor Lighhouse II

Primary specialty

Adult Care Home FacilityTaxonomy code 311ZA0620X

License

ALH-6343 Issued in AZ

Legal business name

THE HARBOR LIGHHOUSE II

Practice address

4142 W Grovers Ave
Glendale, AZ 85308-2926

Phone

(602) 358-8604

Fax

(602) 606-2356

NPI assigned

Nov 26, 2009

Organization subpart

No

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

Authorized official

Name

Costel Tirdea

Title

Owner

Phone

(602) 358-8604

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1259193600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1259193600000",
    "number": "1336477520",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4142 W GROVERS AVE",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "853082926",
            "telephone_number": "602-358-8604",
            "fax_number": "602-606-2356"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4142 W GROVERS AVE",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "853082926",
            "telephone_number": "602-358-8604",
            "fax_number": "602-606-2356"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE HARBOR LIGHHOUSE II",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-11-26",
        "last_updated": "2009-11-26",
        "status": "A",
        "authorized_official_last_name": "TIRDEA",
        "authorized_official_first_name": "COSTEL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "602-358-8604"
    },
    "taxonomies": [
        {
            "code": "311ZA0620X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility, Adult Care Home",
            "state": "AZ",
            "license": "ALH-6343",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ASSISTED LIVING HOME LICENSE",
            "identifier": "AHL-6343",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Adult Care Home Facility in Glendale, AZ
• Providers in Glendale, AZ by specialty
• Adult Care Home Facility in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 26, 2009; 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.