Edelweiss Assisted Living LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

EDELWEISS ASSISTED LIVING LLC

Practice address

19918 N 65TH Ave
Glendale, AZ 85308-7088

Phone

(602) 456-0041

NPI assigned

Dec 1, 2018

Organization subpart

No

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

Authorized official

Name

Mr. Man Mohan Sugathan

Title

Owner

Phone

(602) 456-0041

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1543622400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1543622400000",
    "number": "1992275028",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19918 N 65TH AVE",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "853087088",
            "telephone_number": "602-456-0041"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19918 N 65TH AVE",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "853087088",
            "telephone_number": "602-456-0041"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EDELWEISS ASSISTED LIVING LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-12-01",
        "last_updated": "2018-12-01",
        "status": "A",
        "authorized_official_last_name": "SUGATHAN",
        "authorized_official_first_name": "MAN MOHAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "602-456-0041",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 1, 2018; 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.