Crystal Lodge Investors
LBN: The Lodge At 14Th St.
Crystal Lodge Investors is an health care organization with primary practice located at 2941 N 14Th St , Phoenix AZ 85014-5604. The organization recently has 2 registered licenses in different health care specialties including Ambulatory Health Care Facilities / Clinic/Center, Hospitals / Religious Nonmedical Health Care Institution. Hospitals / Religious Nonmedical Health Care Institution is the primary health care specialty.
The Lodge At 14Th St. can be contacted via phone (602) 279-1033, or through Garvey, John via phone (602) 279-1033.
Contact Information
Primary practice address
2941 N 14Th St
Phoenix AZ 85014-5604
Phone: (602) 279-1033
Fax: (602) 277-5604
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Ambulatory Health Care Facilities / Clinic/Center | 261Q00000X | ALC 4746 | Arizona |
| Hospitals / Religious Nonmedical Health Care Institution | 282J00000X | ALC-4746 | Arizona |
Profile Details
| NPI number | 1083698328 |
|---|---|
| LBN Legal business name | The Lodge At 14Th St. |
| DBA Doing business as | Crystal Lodge Investors |
| Authorized official | Garvey, John |
| Entity | Organization |
| Organization subpart 1 | No |
| Enumeration date | Nov 30th, 2005 |
| Last updated | Aug 19th, 2008 - about 16 years ago |
1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1083698328 | NPPES |
| Arizona | MEDICAID | 629256 | |
| Arizona | MEDICAID | 629-256 |
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