Healthcare Provider Details

I. General information

NPI: 1295768620
Provider Name (Legal Business Name): AHC OF MESA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2006
Last Update Date: 09/15/2025
Certification Date: 09/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5755 E MAIN ST
MESA AZ
85205-8814
US

IV. Provider business mailing address

5755 E MAIN ST
MESA AZ
85205-8814
US

V. Phone/Fax

Practice location:
  • Phone: 480-214-2400
  • Fax: 480-214-2450
Mailing address:
  • Phone: 480-214-2400
  • Fax: 480-214-2450

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: NATHAN OXNAM
Title or Position: PRESIDENT
Credential:
Phone: 385-622-4500