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THE LODGE AT 14TH ST. NPI 1083698328


NPI Information

NPI: 1083698328
Provider Name: THE LODGE AT 14TH ST.

Former Legal Business Name: CRYSTAL LODGE INVESTORS

Classification: Religious Nonmedical Health Care Institution - 282J00000X
Entity Type: Organization
Address:
2941 N 14TH ST
PHOENIX, AZ
ZIP 85014
Phone: (602) 279-1033
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THE LODGE AT 14TH ST. is a religious nonmedical health care institution in Phoenix, AZ. The provider is furnishes only nonmedical nursing items and services to patients who choose to rely solely upon a religious method of healing, and for whom the acceptance of medical services would be inconsistent with their religious beliefs. Furnishes nonmedical items and services exclusively through nonmedical nursing personnel who are experienced in caring for the physical needs of nonmedical patients. For example, caring for the physical needs such as assistance with activities of daily living; assistance in moving, positioning, and ambulation; nutritional needs; and comfort and support measures. Furnishes nonmedical items and services to inpatients on a 24-hour basis. Does not furnish, on the basis of religious beliefs, through its personnel or otherwise, medical items and services (including any medical screening, examination, diagnosis, prognosis, treatment, or the administration of drugs) for its patients. THE LODGE AT 14TH ST. NPI is 1083698328. The provider is registered as an organization entity type.
The provider Former Legal Business Name Is Crystal Lodge Investors.

The provider's business location address is:

2941 N 14TH ST
PHOENIX, AZ
ZIP 85014-604
Phone: (602) 279-1033
Fax: (602) 277-5604

The provider's authorized official is John Garvey .
The authorized official title is General Partner and has the following contact phone number (602) 279-1033.

The enumeration date for this NPI number is 11/30/2005 and was last updated on 8/19/2008.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1261Q00000XClinic/CenterALC 4746ARIZONANo
2282J00000XReligious Nonmedical Health Care InstitutionALC-4746ARIZONAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1629-256MEDICAIDARIZONA
2629256MEDICAIDARIZONA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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