Provider Demographics
NPI:1275163214
Name:ALPINE VILLA LLC
Entity Type:Organization
Organization Name:ALPINE VILLA LLC
Other - Org Name:ALPINE VILLA LINDNER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:GLADE
Authorized Official - Last Name:MAUGHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-292-2010
Mailing Address - Street 1:6439 W WILLOW AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85304-1050
Mailing Address - Country:US
Mailing Address - Phone:602-292-2010
Mailing Address - Fax:
Practice Address - Street 1:17219 N LINDNER DR
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-3308
Practice Address - Country:US
Practice Address - Phone:602-975-8247
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-17
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0630XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Behavioral Disturbances
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness