Healthcare Provider Details

I. General information

NPI: 1194396606
Provider Name (Legal Business Name): KIERLAND CARE ASSISTED LIVING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2021
Last Update Date: 07/06/2021
Certification Date: 07/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7044 E THUNDERBIRD RD
SCOTTSDALE AZ
85254-4049
US

IV. Provider business mailing address

987 W WASHINGTON ST UNIT E115
TEMPE AZ
85281-1291
US

V. Phone/Fax

Practice location:
  • Phone: 609-456-5625
  • Fax: 480-795-8812
Mailing address:
  • Phone: 609-456-5625
  • Fax: 480-795-8812

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: WINSTON GAW
Title or Position: OWNER
Credential:
Phone: 609-456-5625