Provider Demographics
NPI:1659038719
Name:91ST AVENUE OPERATIONS LLC
Entity type:Organization
Organization Name:91ST AVENUE OPERATIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROWAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:FARBER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-230-0444
Mailing Address - Street 1:3000 N 91ST AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85037-4037
Mailing Address - Country:US
Mailing Address - Phone:623-303-2882
Mailing Address - Fax:
Practice Address - Street 1:3000 N 91ST AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85037-4037
Practice Address - Country:US
Practice Address - Phone:623-303-2882
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-23
Last Update Date:2021-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility