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General NPI Number Information
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NPI Number | 1447548466
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Entity Type | Organization
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Legal Business Name | ANGEL'S HEART ASSISTED LIVING
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Dates
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Enumeration Date | 07/11/2011
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Last Update Date | 11/13/2011
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Provider Practice Location Address
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Address Line | 7815 E OBISPO AVE
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City | MESA
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State | AZ
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Zip | 85212-1524
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Country | US
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Telephone | 480-415-3732
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Fax | 480-380-3083
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Provider Business Mailing Address
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Address Line | 7815 E OBISPO AVE
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City | MESA
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State | AZ
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Zip | 85212-1524
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Country | US
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Telephone | 480-415-3732
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Fax | 480-380-3083
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Authorized Official
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Title or Position | OWNER /MANAGER
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Name | KATRINA KAY THAMES
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Credential |
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Telephone | 480-343-1604
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 385H00000X
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Taxonomy Name | Respite Care
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License Number |
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License Number State |
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