Provider Demographics
NPI:1598908097
Name:MILESTONE OPERATIONS LLC
Entity Type:Organization
Organization Name:MILESTONE OPERATIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:WIESNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-882-4500
Mailing Address - Street 1:22 N ROBSON
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85201-7330
Mailing Address - Country:US
Mailing Address - Phone:480-649-3000
Mailing Address - Fax:
Practice Address - Street 1:22 N ROBSON
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85201-7330
Practice Address - Country:US
Practice Address - Phone:480-649-3000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-13
Last Update Date:2009-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZALC6718310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility