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General NPI Number Information
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NPI Number | 1831886340
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Entity Type | Organization
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Legal Business Name | HEAVEN CARE RESIDENTIAL LLC
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Dates
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Enumeration Date | 04/24/2023
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Last Update Date | 07/06/2023
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Provider Practice Location Address
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Address Line | 1707 E CITATION LN
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City | TEMPE
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State | AZ
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Zip | 85284-1606
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Country | US
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Telephone | 480-999-0293
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Fax | 833-286-8210
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Provider Business Mailing Address
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Address Line | 1707 E CITATION LN
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City | TEMPE
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State | AZ
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Zip | 85284-1606
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Country | US
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Telephone | 480-999-0293
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Fax | 833-286-8210
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Authorized Official
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Title or Position | OWNER
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Name | MR. WESLEY YOUNG JR.
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Credential |
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Telephone | 480-999-0293
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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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