Provider Demographics
NPI:1083211288
Name:KINDRED HEARTS ASSISTED LIVING LLC
Entity Type:Organization
Organization Name:KINDRED HEARTS ASSISTED LIVING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:CHAUNCEY
Authorized Official - Middle Name:R
Authorized Official - Last Name:TONEY
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:602-563-9865
Mailing Address - Street 1:530 E MARIPOSA ST APT 26
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-1636
Mailing Address - Country:US
Mailing Address - Phone:602-563-9865
Mailing Address - Fax:
Practice Address - Street 1:530 E MARIPOSA ST APT 26
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85012-1636
Practice Address - Country:US
Practice Address - Phone:602-563-9865
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-01
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty
No310400000XNursing & Custodial Care FacilitiesAssisted Living FacilityGroup - Single Specialty