Provider Demographics
NPI:1447498852
Name:AHC OF GLENDALE LLC
Entity type:Organization
Organization Name:AHC OF GLENDALE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:OXNAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-447-9860
Mailing Address - Street 1:16825 N 63RD AVENUE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85306-1001
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:16825 N 63RD AVENUE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85306-1001
Practice Address - Country:US
Practice Address - Phone:208-740-9076
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NEW AHC HOLDINGS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-01-23
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
035275Medicare Oscar/Certification