Healthcare Provider Details

I. General information

NPI: 1588577852
Provider Name (Legal Business Name): AZ ASSISTED LIVING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2026
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21894 S 199TH WAY
QUEEN CREEK AZ
85142-7364
US

IV. Provider business mailing address

21894 S 199TH WAY
QUEEN CREEK AZ
85142-7364
US

V. Phone/Fax

Practice location:
  • Phone: 480-834-8000
  • Fax: 877-834-8008
Mailing address:
  • Phone: 480-834-8000
  • Fax: 877-834-8008

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: BRADY GARRARD
Title or Position: OWNER
Credential:
Phone: 480-834-8000