Provider Demographics
NPI:1992911267
Name:ALDCO INVESTMENT #3
Entity type:Organization
Organization Name:ALDCO INVESTMENT #3
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER C.O.O.
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:KLASCHKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-265-9813
Mailing Address - Street 1:2935 N 18TH PL
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-7726
Mailing Address - Country:US
Mailing Address - Phone:602-265-9813
Mailing Address - Fax:
Practice Address - Street 1:2935 N 18TH PL
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-7726
Practice Address - Country:US
Practice Address - Phone:602-265-9813
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ077927OtherAHCCCS PROVIDER ID NUMBER