THE LODGE AT 14TH ST. NPI 1083698328

NPI Information

NPI: 1083698328
Provider Name: THE LODGE AT 14TH ST.
Classification: Assisted Living Facility - 310400000X
Entity Type: Organization
Former Legal Business Name: CRYSTAL LODGE INVESTORS
Address: 2941 N 14TH ST
PHOENIX, AZ
ZIP 85014
Phone: (602) 279-1033

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NPI Details

THE LODGE AT 14TH ST. is an assisted living facility in Phoenix, AZ. The provider is 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. 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 10/23/2024.

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 Code	Taxonomy Clasification	License Number	License State	Primary
1	261Q00000X	Clinic/Center	ALC 4746	ARIZONA	No
2	282J00000X	Religious Nonmedical Health Care Institution	ALC-4746	ARIZONA	No
3	310400000X	Assisted Living Facility			Yes

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 Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	629-256	MEDICAID	ARIZONA
2	629256	MEDICAID	ARIZONA

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: 11/21/2025

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