PHOENIX SENIOR LIVING LLC (NPI# 1154541324) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1154541324 |
| Entity Type | Organization |
| Organization Name | PHOENIX SENIOR LIVING LLC |
| Other Organization Name | WILLOW CREEK ASSISTED LIVING & MEMORY CARE COMMUNITY |
| Practice Address |
12322 N 13th Avenue Youngtown AZ 85363 |
| Mailing Address |
Po Box 3006 Salem OR 97302-0006 |
| Practice Telephone | 6235832460 |
| Practice Fax Number | 5034851279 |
| Mailing Telephone | 5034858697 |
| Mailing Fax Number | 5034851279 |
| Enumeration Date | 2007-04-27 |
| Last Update Date | 2008-07-23 |
| Authorized Official Name | JON M HARDER (MANAGER) |
| Authorized Official Telephone | 5034858697 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 311500000X | Alzheimer Center (Dementia Center) | ALC5613 | AZ | Nursing & Custodial Care Facilities |
| Y | 310400000X | Assisted Living Facility | ALC5613 | AZ | Nursing & Custodial Care Facilities |
| Other Name | Type Code |
|---|---|
| Willow Creek Assisted Living & Memory Care Community | Doing Business As Name - Organization |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Alabama Business Registrations | PHOENIX SENIOR LIVING LLC | 114 Townpark Drive, Suite 175, Kennesaw, GA 30144 |
| Street Address |
12322 N 13TH AVENUE |
| City | YOUNGTOWN |
| State | AZ |
| Zip Code | 85363 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710495387 | Sage Counseling, Inc. | Community/Behavioral Health | 12600 N. 113th Ave., Building B, Suite 6, Phoenix, AZ 85363 | 2018-01-17 |
| 1770026361 | Lifestream Complete Senior Living, Inc. | Skilled Nursing Facility | 11521 W. Peoria Avenue, Youngtown, AZ 85363 | 2016-11-30 |
| 1760925358 | Lifestream Complete Senior Living, Inc. | Skilled Nursing Facility | 11523 W. Peoria Avenue, Youngtown, AZ 85363 | 2016-11-30 |
| 1043753635 | Lifestream Complete Senior Living, Inc. | Skilled Nursing Facility | 11527 W. Peoria Avenue, Suite 500, Youngtown, AZ 85363 | 2016-11-30 |
| 1992257539 | Allen Michael Moore | Pharmacist | 10727 W. Olive Ave., Youngtown, AZ 85363 | 2016-10-31 |
| 1295010007 | Laura Nichols | Dentist | 11132 California Ave, Youngtown, AZ 85363 | 2011-10-13 |
| 1265509319 | John E Cooper II | Dentist | 11126 West Wisconsin Avenue, Suite 1, Youngtown, AZ 85363 | 2006-11-30 |
| 1194783886 | Mark Paul Yates | Dentist | 11100 W Michigan Ave, Youngtown, AZ 85363 | 2006-05-02 |
| 1447646146 | Rajkumar Sugumaran Md Pllc | Internal Medicine | 11124 W California Ave, # G, Youngtown, AZ 85363 | 2015-04-09 |
| 1659451771 | David M Mengel | Denturist | 11100 W Michigan Ave, Youngtown, AZ 85363-1017 | 2006-10-16 |
| Find all providers in zip 85363 | ||||
| Taxonomy Code | 310400000X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Assisted Living Facility |
| A facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205456084 | Lifestream Complete Senior Living Inc | Assisted Living Facility | 11525 W Peoria Ave, Youngtown, AZ 85363-1640 | 2020-04-21 |
| 1942736582 | Ventana Winds LLC | Assisted Living Facility | 12322 N 113th Ave, Youngtown, AZ 85363-1268 | 2017-05-02 |
| 1225496268 | Advantage Home Care, LLC | Assisted Living Facility | 11510 W Langford Ct, Youngtown, AZ 85363-1426 | 2016-02-05 |
| 1841513215 | Lifestream Complete Senior Living Inc | Assisted Living Facility | 11527 W Peoria Ave, Youngtown, AZ 85363-1640 | 2010-03-12 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235730508 | Gheorghe Patrutescu | Assisted Living Facility | 16134 N 72nd Ln, Peoria, AZ 85382-4937 | 2020-11-03 |
| 1942800966 | Yibu Liu | Assisted Living Facility | 3569 E Utopia Rd, Phoenix, AZ 85050-3967 | 2020-10-28 |
| 1386243269 | Harmony House Tucson LLC | Assisted Living Facility | 12651 E Speedway Blvd, Tucson, AZ 85748-2060 | 2020-10-21 |
| 1710586664 | Sunland Springs Memory Care, LLC | Assisted Living Facility | 2415 S Signal Butte Rd, Mesa, AZ 85209-2107 | 2020-10-21 |
| 1487253860 | Ronald Jingco Calaguas | Assisted Living Facility | 2432 W Portobello Ave, Mesa, AZ 85202-7871 | 2020-10-18 |
| 1992303374 | Azi House LLC | Assisted Living Facility | 1200 W Chapala Dr, Tucson, AZ 85704-4521 | 2020-10-16 |
| 1609474030 | Fisher Family Home LLC | Assisted Living Facility | 2927 W Redfield Rd, Phoenix, AZ 85053-7712 | 2020-10-16 |
| 1235736687 | Ana's Assisted Living Home, LLC | Assisted Living Facility | 13238 N 35th St, Phoenix, AZ 85032-6110 | 2020-10-07 |
| 1205433844 | Angelic Care LLC | Assisted Living Facility | 15247 W Wethersfield Rd, Surprise, AZ 85379-9177 | 2020-10-07 |
| 1689281347 | Gilbert Al Partners, Lp | Assisted Living Facility | 1445 E Willis Rd, Gilbert, AZ 85297-7352 | 2020-09-28 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.