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General NPI Number Information
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NPI Number | 1023770021
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Entity Type | Organization
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Legal Business Name | KISSLING MANOR ALH LLC
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Dates
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Enumeration Date | 10/07/2021
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Last Update Date | 10/07/2021
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Provider Practice Location Address
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Address Line | 15456 W MORNING GLORY ST
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City | GOODYEAR
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State | AZ
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Zip | 85338-6907
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Country | US
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Telephone | 623-518-4649
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Fax |
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Provider Business Mailing Address
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Address Line | 15456 W MORNING GLORY ST
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City | GOODYEAR
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State | AZ
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Zip | 85338-6907
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Country | US
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Telephone | 623-518-4649
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Fax |
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Authorized Official
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Title or Position | OWNER/MEMBER
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Name | MR. STEVEN PAUL HORST
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Credential |
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Telephone | 602-725-6636
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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 |
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License Number State |
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