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General NPI Number Information
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NPI Number | 1013461268
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Entity Type | Organization
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Legal Business Name | MRSC AZ APACHE JUNCTION MASTER TENANT, LLC
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Dates
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Enumeration Date | 08/04/2016
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Last Update Date | 02/05/2025
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Provider Practice Location Address
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Address Line | 1510 E BROADWAY AVE BLDG 1
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City | APACHE JUNCTION
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State | AZ
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Zip | 85119-5301
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Country | US
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Telephone | 480-671-1490
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Fax |
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Provider Business Mailing Address
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Address Line | 1510 E BROADWAY AVE BLDG 1
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City | APACHE JUNCTION
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State | AZ
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Zip | 85119-5301
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CO-MANAGER
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Name | GARY LANGENDOEN
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Credential |
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Telephone | 626-796-8700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | AL10066C
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License Number State | AZ
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