| The Lodge At 14th St. | |
|
2941 N 14th St Phoenix AZ 85014-5604 | |
| (602) 279-1033 | |
| (602) 277-5604 |
| Full Name | The Lodge At 14th St. |
|---|---|
| Speciality | Religious Nonmedical Health Care Institution |
| Location | 2941 N 14th St, Phoenix, Arizona |
| Authorized Official Name and Position | John Garvey (GENERAL PARTNER) |
| Authorized Official Contact | 6022791033 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| The Lodge At 14th St. 2941 N. 14th St. Phoenix AZ 85014-5604 Ph: (602) 279-1033 | The Lodge At 14th St. 2941 N 14th St Phoenix AZ 85014-5604 Ph: (602) 279-1033 |
| NPI Number | 1083698328 |
|---|---|
| Provider Enumeration Date | 11/30/2005 |
| Last Update Date | 08/19/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1083698328 | NPI | - | NPPES |
| 629256 | Medicaid | AZ | |
| 629-256 | Medicaid | AZ |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | ALC 4746 (Arizona) | Secondary |
| 282J00000X | Religious Nonmedical Health Care Institution | ALC-4746 (Arizona) | Primary |
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