Solterra 3Rd Indian School Operations, LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

AL10641C Issued in AZ

Legal business name

SOLTERRA 3RD INDIAN SCHOOL OPERATIONS, LLC

Doing business as

Bridgewater Assisted Living - Midtown

Practice address

4000 N 3Rd Avenue
Phoenix, AZ 85013

Phone

(480) 653-9500

NPI assigned

Apr 18, 2018

Organization subpart

No

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

Authorized official

Name

Mrs. Inge G Duran

Title

Vice President of Finance

Phone

(602) 544-3195

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Bridgewater Assisted Living - Midtown Doing business as

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

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

{
    "created_epoch": "1524009600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1524009600000",
    "number": "1467949156",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14650 N 78TH WAY, BLDG B",
            "city": "SCOTTSDALE",
            "state": "AZ",
            "postal_code": "85260",
            "telephone_number": "602-544-3195",
            "fax_number": "602-533-7574"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4000 N 3RD AVENUE",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "85013",
            "telephone_number": "480-653-9500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOLTERRA 3RD INDIAN SCHOOL OPERATIONS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-04-18",
        "last_updated": "2018-04-18",
        "status": "A",
        "authorized_official_last_name": "DURAN",
        "authorized_official_first_name": "INGE",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "VICE PRESIDENT OF FINANCE",
        "authorized_official_telephone_number": "602-544-3195",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "AZ",
            "license": "AL10641C",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AZ DEPT HEALTH SVCS",
            "identifier": "AL10641C",
            "state": "AZ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "367767",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bridgewater Assisted Living - Midtown",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jose Angelo Lagumbay Solon
• Gabrielle Solorzano, SLPA
• Jonathan Solorzano
• Molly Elizabeth Solorzano, MD
• Gigi Soltero, LPN
• Solterra Deer Valley Operations, LLC
• Solterra Dentistry LLC
• Jennifer Soltis
• Solution Behavioral Health LLC
• Solutions Integrated LLC

• Assisted Living Facility in Phoenix, AZ
• Providers in Phoenix, 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 Apr 18, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.