- Enrollment id
- O20120926000629
- Enrollment state
- AZ
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1114273778
- Multiple npi flag
- N
- Ccn
- 035084
- Associate id
- 4789718719
- Organization name
- PLAZA HC HOLDING COMPANY LLC
- Doing business as name
- PLAZA HEALTHCARE
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Nursing home provider name
- PLAZA HEALTHCARE
- Address line 1
- 1475 N GRANITE REEF RD
- City
- SCOTTSDALE
- State
- AZ
- Zip code
- 852573919