Healthcare Provider Details

I. General information

NPI: 1558954552
Provider Name (Legal Business Name): MIRABELLA AT ASU, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2021
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 E UNIVERSITY DR
TEMPE AZ
85281-1091
US

IV. Provider business mailing address

1 W MAIN ST STE 303
MEDFORD OR
97501-2796
US

V. Phone/Fax

Practice location:
  • Phone: 602-777-7701
  • Fax:
Mailing address:
  • Phone: 888-724-6424
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: THOMAS DOROUGH
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 480-371-6101