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General NPI Number Information
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NPI Number | 1558954552
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Entity Type | Organization
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Legal Business Name | MIRABELLA AT ASU, INC
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Dates
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Enumeration Date | 02/19/2021
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Last Update Date | 12/11/2025
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Provider Practice Location Address
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Address Line | 65 E UNIVERSITY DR
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City | TEMPE
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State | AZ
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Zip | 85281-1091
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Country | US
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Telephone | 602-777-7701
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Fax |
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Provider Business Mailing Address
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Address Line | 1 W MAIN ST STE 303
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City | MEDFORD
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State | OR
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Zip | 97501-2796
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Country | US
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Telephone | 888-724-6424
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | THOMAS DOROUGH
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Credential |
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Telephone | 480-371-6101
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number |
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License Number State |
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