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General NPI Number Information
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NPI Number | 1992910079
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Entity Type | Organization
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Legal Business Name | LEISURE LIVING AT SUNDOWN RANCH
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Dates
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Enumeration Date | 05/11/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 7838 E SHEA BLVD
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City | SCOTTSDALE
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State | AZ
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Zip | 85260-5535
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Country | US
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Telephone | 480-596-1298
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Fax | 480-596-3570
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Provider Business Mailing Address
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Address Line | 7838 E SHEA BLVD
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City | SCOTTSDALE
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State | AZ
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Zip | 85260-5535
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Country | US
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Telephone | 480-596-1298
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Fax | 480-596-3570
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Authorized Official
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Title or Position | OWNER
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Name | MR. CHUCK ZIMMERMAN II
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Credential | MANAGER
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Telephone | 480-596-1298
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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 | ALH5042
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License Number State | AZ
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