Provider Demographics
NPI:1568985554
Name:LESAN ASSISTED LIVING, L.L.C.
Entity Type:Organization
Organization Name:LESAN ASSISTED LIVING, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER AND MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:RENE
Authorized Official - Middle Name:
Authorized Official - Last Name:LEON
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:520-234-5776
Mailing Address - Street 1:2340 E PRIMROSE ST
Mailing Address - Street 2:
Mailing Address - City:DOUGLAS
Mailing Address - State:AZ
Mailing Address - Zip Code:85607-5102
Mailing Address - Country:US
Mailing Address - Phone:520-505-6528
Mailing Address - Fax:
Practice Address - Street 1:2340 E PRIMROSE ST
Practice Address - Street 2:
Practice Address - City:DOUGLAS
Practice Address - State:AZ
Practice Address - Zip Code:85607-5102
Practice Address - Country:US
Practice Address - Phone:520-505-6528
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-20
Last Update Date:2021-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAL10280H310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ260616Medicaid