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NPI Code Detail

MEDICARE: CASA DE VIDA LIVING LLC

MEDICARE: CASA DE VIDA LIVING LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1310400000XAssisted Living Facility

General Provider Information

NPI Number : 1720602832
Entity Type Code : Organization
Provider Name (Legal Business Name) : CASA DE VIDA LIVING LLC
Provider Business Mailing Address
First Line : 7036 W PARKWAY DR
Second Line :
City : PHOENIX
State : AZ
Zip : 85043-6921
Country : US
Telephone Number : 602-696-6249
Fax Number :
Provider Business Practice Location Address
First Line : 7036 W PARKWAY DR
Second Line :
City : PHOENIX
State : AZ
Zip : 85043-6921
Country : US
Telephone Number : 602-696-6249
Fax Number :
Authorized Official
Title or Position : CEO
Name : MR. BRENT LEE BLUNT
Credential : AL-MANAGER
Telephone Number : 602-696-6249
Provider Enumeration Date : 06/04/2020
Last Update Date : 06/04/2020

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Directions to “CASA DE VIDA LIVING LLC ” Practice Location

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