Healthcare Provider Details

I. General information

NPI: 1457565699
Provider Name (Legal Business Name): LEISURE LIVING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8424 E VIA DE ENCANTO
SCOTTSDALE AZ
85258-3908
US

IV. Provider business mailing address

8424 E VIA DE ENCANTO
SCOTTSDALE AZ
85258-3908
US

V. Phone/Fax

Practice location:
  • Phone: 480-348-0759
  • Fax: 480-348-1531
Mailing address:
  • Phone: 480-348-0759
  • Fax: 480-348-1531

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License NumberALH3199
License Number StateAZ

VIII. Authorized Official

Name: MR. CLINT C ZIMMERMAN II
Title or Position: OWNER
Credential: MANAGER
Phone: 480-348-0759