NPIMap

Organization Active NPI

Extended Care Portfolio Multistate Pool Tenant, LLC

  • Assisted Living Facility
  • Phoenix, AZ
National Provider Identifier
1730314626
Registry record updated May 20, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Assisted Living FacilityTaxonomy code 310400000X
License
ALC-6667 Issued in AZ
Legal business name
EXTENDED CARE PORTFOLIO MULTISTATE POOL TENANT, LLC
Practice address
16621 N 38TH St
Phoenix, AZ 85032-2102
Phone
(602) 787-0800
NPI assigned
May 20, 2009
Last updated
May 20, 2009By the provider in NPPES
Organization subpart
Yes
Parent organization
EXTENDED CARE PORTFOLIO TENANT, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 20, 2009

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

Authorized official

Name
Peter Richardson
Title
Controller
Phone
(503) 905-3303

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Assisted Living Facility 310400000X ALC-6667 AZ Primary

Addresses

Primary practice location

16621 N 38TH St
Phoenix, AZ 85032-2102

Mailing address

6400 SE Lake Rd
Suite 400
Milwaukie, OR 97222-2129
Phone (503) 905-3303

Other identifiers 1

IdentifierTypeStateIssuer
358816OtherAZARIZONA HEALTH CARE COST CONTAINMENT SYSTEM

Other names 1

  • Encore Senior Village at Paradise Valley Other name

National Provider Directory

National Provider Directory
Tax ID family
Extended Care Portfolio Florida Tenant LLC11 organizations share this tax ID, including this one
Part of
Extended Care Portfolio Florida Tenant LLC

Other organizations with this tax ID 10

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": "1242777600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1242777600000",
    "number": "1730314626",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6400 SE LAKE RD",
            "address_2": "SUITE 400",
            "city": "MILWAUKIE",
            "state": "OR",
            "postal_code": "972222129",
            "telephone_number": "503-905-3303"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16621 N 38TH ST",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850322102",
            "telephone_number": "602-787-0800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EXTENDED CARE PORTFOLIO MULTISTATE POOL TENANT, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "EXTENDED CARE PORTFOLIO TENANT, LLC",
        "enumeration_date": "2009-05-20",
        "last_updated": "2009-05-20",
        "status": "A",
        "authorized_official_last_name": "RICHARDSON",
        "authorized_official_first_name": "PETER",
        "authorized_official_title_or_position": "CONTROLLER",
        "authorized_official_telephone_number": "503-905-3303"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "AZ",
            "license": "ALC-6667",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM",
            "identifier": "358816",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Encore Senior Village at Paradise Valley",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Phoenix, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 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.