Provider Demographics
NPI:1548707524
Name:ARCADIA ASSISTED CARE, LLC
Entity type:Organization
Organization Name:ARCADIA ASSISTED CARE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:BROOKE
Authorized Official - Middle Name:
Authorized Official - Last Name:BLAIR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-410-8698
Mailing Address - Street 1:3714 E PICCADILLY RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018-5133
Mailing Address - Country:US
Mailing Address - Phone:602-410-8698
Mailing Address - Fax:602-954-0639
Practice Address - Street 1:4132 E CAMELBACK RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85018-2717
Practice Address - Country:US
Practice Address - Phone:602-410-8698
Practice Address - Fax:602-954-0639
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ARCADIA ASSISTED CARE, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-01-27
Last Update Date:2017-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAL8889H310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ788802Medicaid