Basic Information
| Provider Information | |||||||||
| NPI: | 1417407693 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ALLEGIANT HEALTHCARE WEST, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4711 GOLF RD STE 200 | ||||||||
| Address2: | |||||||||
| City: | SKOKIE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600761236 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 3130 E BROADWAY RD | ||||||||
| Address2: | |||||||||
| City: | MESA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852041740 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4809247777 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/11/2016 | ||||||||
| LastUpdateDate: | 10/11/2016 | ||||||||
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| AuthorizedOfficialLastName: | WEINTRAUB | ||||||||
| AuthorizedOfficialFirstName: | JAKE | ||||||||
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| AuthorizedOfficialTitleorPosition: | MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 8479339280 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.