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General NPI Number Information
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NPI Number | 1568985554
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Entity Type | Organization
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Legal Business Name | LESAN ASSISTED LIVING, L.L.C.
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Dates
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Enumeration Date | 07/20/2017
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Last Update Date | 11/08/2021
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Provider Practice Location Address
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Address Line | 2340 E PRIMROSE ST
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City | DOUGLAS
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State | AZ
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Zip | 85607-5102
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Country | US
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Telephone | 520-505-6528
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Fax |
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Provider Business Mailing Address
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Address Line | 2340 E PRIMROSE ST
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City | DOUGLAS
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State | AZ
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Zip | 85607-5102
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Country | US
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Telephone | 520-505-6528
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Fax |
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Authorized Official
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Title or Position | OWNER AND MANAGER
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Name | MR. RENE LEON JR.
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Credential |
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Telephone | 520-234-5776
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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 | AL10280H
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License Number State | AZ
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