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General NPI Number Information
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NPI Number | 1275163214
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Entity Type | Organization
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Legal Business Name | ALPINE VILLA LLC
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Dates
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Enumeration Date | 01/17/2020
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Last Update Date | 01/16/2024
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Provider Practice Location Address
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Address Line | 17219 N LINDNER DR
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City | GLENDALE
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State | AZ
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Zip | 85308-3308
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Country | US
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Telephone | 602-975-8247
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Fax |
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Provider Business Mailing Address
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Address Line | 6439 W WILLOW AVE
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City | GLENDALE
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State | AZ
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Zip | 85304-1050
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Country | US
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Telephone | 602-292-2010
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | ERIC GLADE MAUGHAN
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Credential |
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Telephone | 602-292-2010
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number |
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License Number State |
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