Healthcare Provider Details

I. General information

NPI: 1205756616
Provider Name (Legal Business Name): EAST VALLEY MANSION ASSISTED LIVING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2026
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3368 E SUNNYDALE DR
QUEEN CREEK AZ
85142-7312
US

IV. Provider business mailing address

3368 E SUNNYDALE DR
QUEEN CREEK AZ
85142-7312
US

V. Phone/Fax

Practice location:
  • Phone: 480-988-0445
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: NICHOLAS VILLEGAS
Title or Position: DIRECTOR
Credential:
Phone: 818-636-5759