19TH Avenue Operations, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

NCI-2694 Issued in AZ

Legal business name

19TH AVENUE OPERATIONS, LLC

Doing business as

The Palazzo

Practice address

6246 N 19TH Ave
Phoenix, AZ 85015-1511

Phone

(602) 433-6300

Fax

(602) 433-6458

NPI assigned

May 20, 2016

Last updated

Jan 4, 2017By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Tracy L. Clark Jr.

Title

Authorized Representative

Phone

(310) 337-1929

Specialties & licenses 3

Addresses

Other names 1

• The Palazzo Doing business as

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Fadi Alrabadi, MD

  • Internal Medicine Physician
  • Phoenix, AZ
  • NPI 1609131499
  NPD (past)

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

{
    "created_epoch": "1463702400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1483488000000",
    "number": "1649627423",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 CORPORATE POINTE",
            "address_2": "SUITE 100",
            "city": "CULVER CITY",
            "state": "CA",
            "postal_code": "902307690",
            "telephone_number": "310-337-1929",
            "fax_number": "310-861-1661"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6246 N 19TH AVE",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850151511",
            "telephone_number": "602-433-6300",
            "fax_number": "602-433-6458"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "19TH AVENUE OPERATIONS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-05-20",
        "last_updated": "2017-01-04",
        "status": "A",
        "authorized_official_last_name": "CLARK",
        "authorized_official_first_name": "TRACY",
        "authorized_official_middle_name": "L.",
        "authorized_official_title_or_position": "AUTHORIZED REPRESENTATIVE",
        "authorized_official_telephone_number": "310-337-1929",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "AZ",
            "license": "AL10014C",
            "primary": false
        },
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "AZ",
            "license": "AL10013C",
            "primary": false
        },
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "AZ",
            "license": "NCI-2694",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Palazzo",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Skilled Nursing Facility in Phoenix, AZ
• Providers in Phoenix, AZ by specialty
• Skilled Nursing Facility in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 4, 2017; 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.