NPIMap

Organization Active NPI

Life Care Centers of America, Inc.

Doing business as Sun Grove Village Care Center

  • Skilled Nursing Facility
  • Peoria, AZ
National Provider Identifier
1700823606
Registry record updated Sep 15, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
OTC-2061 Issued in AZ
Legal business name
LIFE CARE CENTERS OF AMERICA, INC.
Doing business as
Sun Grove Village Care Center
Practice address
20625 N Lake Pleasant Rd
Peoria, AZ 85382-9704
Phone
(623) 566-0642
Fax
(623) 566-1515
NPI assigned
May 31, 2006
Last updated
Sep 15, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 15, 2021

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

Authorized official

Name
Cindy S Cross
Title
Assistant Secretary
Phone
(423) 473-5867

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X OTC-2061 AZ Primary

Addresses

Primary practice location

20625 N Lake Pleasant Rd
Peoria, AZ 85382-9704

Mailing address

3001 Keith St NW
Cleveland, TN 37312-3713
Phone (423) 473-5751

Other identifiers 1

IdentifierTypeStateIssuer
043581MedicaidAZ

Other names 1

  • Sun Grove Village Care Center Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Esolutions Inc3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1149033600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1631664000000",
    "number": "1700823606",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3001 KEITH ST NW",
            "city": "CLEVELAND",
            "state": "TN",
            "postal_code": "373123713",
            "telephone_number": "423-473-5751",
            "fax_number": "423-339-8342"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20625 N LAKE PLEASANT RD",
            "city": "PEORIA",
            "state": "AZ",
            "postal_code": "853829704",
            "telephone_number": "623-566-0642",
            "fax_number": "623-566-1515"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFE CARE CENTERS OF AMERICA, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-31",
        "last_updated": "2021-09-15",
        "certification_date": "2021-09-15",
        "status": "A",
        "authorized_official_last_name": "CROSS",
        "authorized_official_first_name": "CINDY",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "ASSISTANT SECRETARY",
        "authorized_official_telephone_number": "423-473-5867"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "AZ",
            "license": "OTC-2061",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "043581",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sun Grove Village Care Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Peoria, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 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.