Healthcare Provider Details

I. General information

NPI: 1013461268
Provider Name (Legal Business Name): MRSC AZ APACHE JUNCTION MASTER TENANT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2016
Last Update Date: 02/05/2025
Certification Date: 02/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1510 E BROADWAY AVE BLDG 1
APACHE JUNCTION AZ
85119-5301
US

IV. Provider business mailing address

1510 E BROADWAY AVE BLDG 1
APACHE JUNCTION AZ
85119-5301
US

V. Phone/Fax

Practice location:
  • Phone: 480-671-1490
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License NumberAL10066C
License Number StateAZ

VIII. Authorized Official

Name: GARY LANGENDOEN
Title or Position: CO-MANAGER
Credential:
Phone: 626-796-8700