EAGLE PASS SENIOR LIVING LLC (NPI# 1659936433) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1659936433 |
| Entity Type | Organization |
| Organization Name | EAGLE PASS SENIOR LIVING LLC |
| Other Organization Name | AMARSI ASSISTED LIVING |
| Practice Address |
5125 N 58th Ave Glendale AZ 85301-7453 |
| Practice Telephone | 6239155720 |
| Practice Fax Number | 6239318776 |
| Mailing Telephone | 6239155720 |
| Enumeration Date | 2019-05-07 |
| Last Update Date | 2020-01-23 |
| Authorized Official Name | LEE JOHNSON (TREASURER) |
| Authorized Official Telephone | 2084011369 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 310400000X | Assisted Living Facility | Nursing & Custodial Care Facilities |
| Other Name | Type Code |
|---|---|
| AMARSI ASSISTED LIVING | Doing Business As Name - Organization |
| Street Address |
5125 N 58TH AVE |
| City | GLENDALE |
| State | AZ |
| Zip Code | 85301-7453 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174518013 | Glendale Healthcare Associates LLC | Skilled Nursing Facility | 5125 N 58th Ave, Glendale, AZ 85301-7453 | 2005-09-16 |
| 1861905531 | William A Ennist | Physical Therapy Assistant | 5125 N 58th Ave, Glendale, AZ 85301-7453 | 2017-11-15 |
| 1861905705 | Alysia Audrey Decker | Occupational Therapy Assistant | 5125 N 58th Ave, Glendale, AZ 85301-7453 | 2017-11-14 |
| 1467819417 | Glendale Healthcare Associates LLC | Clinic/Center | 5125 N 58th Ave, Glendale, AZ 85301-7453 | 2016-01-21 |
| 1447680673 | Kelli Hellwig | Physical Therapist | 5125 N 58th Ave, Glendale, AZ 85301-7453 | 2013-11-25 |
| 1841526597 | Stephanie Ruth Patterson | Specialist | 5125 N 58th Ave, Glendale, AZ 85301-7453 | 2009-10-29 |
| 1033444633 | Glendale Healthcare Assoc., LLC | Skilled Nursing Facility | 5125 N 58th Ave, Glendale, AZ 85301-7453 | 2009-10-15 |
| 1386977478 | Roseanne Florento Teh | Physical Therapist | 5125 N 58th Ave, Glendale, AZ 85301-7453 | 2009-09-08 |
| 1912230061 | Thomas David Riter | Occupational Therapy Assistant | 5125 N 58th Ave, Glendale, AZ 85301-7453 | 2009-09-08 |
| 1922331081 | Laura Dawn Henry | Physical Therapist | 5125 N 58th Ave, Glendale, AZ 85301-7453 | 2009-09-08 |
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| 1164051900 | Stateserv Medical of Phoenix LLC | Durable Medical Equipment & Medical Supplies | 5234 W. Missouri, Glendale, AZ 85301 | 2020-04-03 |
| 1366988933 | Sonoran Sky Community Services | Community Based Residential Treatment Facility, Mental Illness | 5148 W. Frier Dr, Glendale, AZ 85301 | 2017-01-06 |
| 1306227830 | Sage Counseling, Inc. | Community/Behavioral Health | 6610 N. 47th Avenue, Suites 6, 7 & 8, Glendale, AZ 85301 | 2015-06-10 |
| 1477802023 | Lori Wyke | Specialist/Technologist | 7301 N. 58th Avenue, Glendale, AZ 85301 | 2012-08-29 |
| 1144581257 | Jerry Harold Brue | Pharmacist | 7772 N 52nd Dr, Glendale, AZ 85301 | 2012-06-05 |
| 1558632935 | Jasmine Rojas | Licensed Practical Nurse | 7301 N. 58th Ave., Glendale Elem. Dist 40, Glendale, AZ 85301 | 2012-01-18 |
| 1184950438 | Victoria Joan Petti | Physical Therapist | 5125 N. 58th Ave, Glendale, AZ 85301 | 2009-10-21 |
| 1598907479 | Westside Speech & Language Services | Clinic/Center | 7415 N. 59th Ave, Glendale, AZ 85301 | 2009-03-24 |
| 1992940241 | Lorraine Pimentel Montes | Specialist | 4441 W. Bethany Home Rd, Glendale, AZ 85301 | 2008-12-15 |
| 1770739922 | Patricia Lee Click | Social Worker | 5400 W. Northern Avenue, Suite 120, Glendale, AZ 85301 | 2008-08-07 |
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| 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] |
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|---|---|---|---|---|
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| 1225673759 | Trinity Assisted Living | Assisted Living Facility | 4541 W Paradise Ln, Glendale, AZ 85306-2729 | 2019-11-07 |
| 1952954489 | Jubilee In The Desert, LLC | Assisted Living Facility | 4321 W Cholla St, Glendale, AZ 85304-3531 | 2019-07-23 |
| 1962054536 | Vema Corporation | Assisted Living Facility | 4802 W Gelding Dr, Glendale, AZ 85306-4438 | 2019-07-12 |
| 1013487180 | Ludovica Rodica Malutan | Assisted Living Facility | 5019 W Paradise Ln, Glendale, AZ 85306-2655 | 2018-11-30 |
| 1144790601 | Terra Pointe Care, LLC | Assisted Living Facility | 5330 W Union Hills Dr, Glendale, AZ 85308-1311 | 2018-11-27 |
| 1316433493 | Andrei Martin | Assisted Living Facility | 6338 W Port Royale Ln, Glendale, AZ 85306-3260 | 2018-07-02 |
| 1841782638 | Goldwater Legacy Assisted Living LLC | Assisted Living Facility | 6640 W Pinnacle Peak Rd, Glendale, AZ 85310-3409 | 2018-06-06 |
| 1932627494 | Dennis J Tan | Assisted Living Facility | 6979 W Cactus Wren Dr, Glendale, AZ 85303-2684 | 2017-09-05 |
| 1568984037 | Angels Paradise Care Home 2, LLC | Assisted Living Facility | 5582 W Becker Ln, Glendale, AZ 85304-3866 | 2017-07-17 |
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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.