Provider Demographics
NPI:1235334541
Name:CC/PDR-SCOTTSDALE, LLC
Entity type:Organization
Organization Name:CC/PDR-SCOTTSDALE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COUNSEL
Authorized Official - Prefix:
Authorized Official - First Name:TOMEK
Authorized Official - Middle Name:J
Authorized Official - Last Name:KOSZYLKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-803-8443
Mailing Address - Street 1:233 S WACKER DR STE 8400
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60606-6316
Mailing Address - Country:US
Mailing Address - Phone:312-803-8800
Mailing Address - Fax:
Practice Address - Street 1:7501 E THOMPSON PEAK PKWY
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85255-4525
Practice Address - Country:US
Practice Address - Phone:480-361-3200
Practice Address - Fax:480-659-5110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-18
Last Update Date:2025-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZNCI-2616314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ035272Medicare Oscar/Certification