Provider Demographics
NPI:1770235988
Name:ARIZONA ALTERNATIVE SUPPORT, LLC
Entity Type:Organization
Organization Name:ARIZONA ALTERNATIVE SUPPORT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:IRENE
Authorized Official - Middle Name:
Authorized Official - Last Name:MULONDO
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN
Authorized Official - Phone:774-253-7365
Mailing Address - Street 1:215 N HOBSON
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85203-7921
Mailing Address - Country:US
Mailing Address - Phone:774-253-7365
Mailing Address - Fax:480-597-5252
Practice Address - Street 1:215 N HOBSON
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85203-7921
Practice Address - Country:US
Practice Address - Phone:774-253-7365
Practice Address - Fax:480-597-5252
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-19
Last Update Date:2022-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0630XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Behavioral Disturbances