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General NPI Number Information
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NPI Number | 1417747429
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Entity Type | Organization
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Legal Business Name | INGE'S UNIQUELY WARM ASSISTED LIVING LLC
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Dates
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Enumeration Date | 05/12/2025
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Last Update Date | 05/12/2025
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Provider Practice Location Address
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Address Line | 1625 S SULLIVAN LN
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City | CAMP VERDE
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State | AZ
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Zip | 86322-6871
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Country | US
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Telephone | 503-607-4519
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Fax |
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Provider Business Mailing Address
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Address Line | 1620 N 25TH PL
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City | PHOENIX
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State | AZ
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Zip | 85008-3515
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Country | US
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Telephone | 503-607-4519
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | RYAN MATTHEW WEAKS
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Credential | MANAGER
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Telephone | 503-607-4519
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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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