Provider Demographics
NPI:1497209647
Name:MRSC AZ MESA MASTER TENANT, LLC
Entity Type:Organization
Organization Name:MRSC AZ MESA MASTER TENANT, LLC
Other - Org Name:VISIONS SENIOR LIVING AT MESA 1
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:STEWART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-241-4992
Mailing Address - Street 1:537 S HIGLEY RD BLDG 1
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-2148
Mailing Address - Country:US
Mailing Address - Phone:480-427-2797
Mailing Address - Fax:
Practice Address - Street 1:537 S HIGLEY RD BLDG 1
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-2148
Practice Address - Country:US
Practice Address - Phone:480-427-2797
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-04
Last Update Date:2016-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAL10068C310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ149133Medicaid
AZ149278Medicaid