Provider Demographics
NPI:1346079043
Name:MATEESCU, LAVINIA E (OWNER, MANAGER)
Entity type:Individual
Prefix:
First Name:LAVINIA
Middle Name:E
Last Name:MATEESCU
Suffix:
Gender:F
Credentials:OWNER, MANAGER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5250 E CAROLINA DR
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-1732
Mailing Address - Country:US
Mailing Address - Phone:623-262-5388
Mailing Address - Fax:
Practice Address - Street 1:18120 N 53RD LN
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-1325
Practice Address - Country:US
Practice Address - Phone:623-262-5388
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-31
Last Update Date:2024-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAL12960H310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility