1306243084 NPI number — RESIDENTS AT THE HEIGHTS LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306243084 NPI number — RESIDENTS AT THE HEIGHTS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RESIDENTS AT THE HEIGHTS LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1306243084
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/12/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3602 E GREENWAY RD
Provider Second Line Business Mailing Address:
SUITE 104
Provider Business Mailing Address City Name:
PHOENIX
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85032-4648
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
602-368-8203
Provider Business Mailing Address Fax Number:
602-368-8211

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
215 S POWER RD STE 1251
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MESA
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85206-5238
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-368-4471
Provider Business Practice Location Address Fax Number:
888-974-1094
Provider Enumeration Date:
11/25/2014

Additional Information

Authorized Official

Authorized Official Last Name:
LEACH
Authorized Official First Name:
MARY
Authorized Official Middle Name:
G
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
602-368-8203

Provider Taxonomy Codes

  • Taxonomy code: 324500000X , with the licence number:  BH5397 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 324500000X , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: BH5397 . This is a "ARIZONA DEPARTMENT OF HEALTH SERVICES" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".




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