Healthcare Provider Details

I. General information

NPI: 1891060638
Provider Name (Legal Business Name): VALLEY OF THE SUN ASSISTED LIVING HOME- EAST LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2012
Last Update Date: 03/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2018 E WAGONER RD
PHOENIX AZ
85022-1433
US

IV. Provider business mailing address

2018 E WAGONER RD
PHOENIX AZ
85022-1433
US

V. Phone/Fax

Practice location:
  • Phone: 480-720-4591
  • Fax:
Mailing address:
  • Phone: 480-720-4591
  • Fax: 602-788-2245

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License NumberAL8565H
License Number StateAZ

VIII. Authorized Official

Name: MIRNES MEHIC
Title or Position: OWNER
Credential:
Phone: 480-720-4591