Provider Demographics
NPI:1194396606
Name:KIERLAND CARE ASSISTED LIVING LLC
Entity Type:Organization
Organization Name:KIERLAND CARE ASSISTED LIVING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WINSTON
Authorized Official - Middle Name:
Authorized Official - Last Name:GAW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-456-5625
Mailing Address - Street 1:987 W WASHINGTON ST UNIT E115
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85281-1291
Mailing Address - Country:US
Mailing Address - Phone:609-456-5625
Mailing Address - Fax:480-795-8812
Practice Address - Street 1:7044 E THUNDERBIRD RD
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85254-4049
Practice Address - Country:US
Practice Address - Phone:609-456-5625
Practice Address - Fax:480-795-8812
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-06
Last Update Date:2021-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility