Provider Demographics
NPI:1831652601
Name:RESIDENTS AT THE HEIGHTS LLC
Entity Type:Organization
Organization Name:RESIDENTS AT THE HEIGHTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:GRACE
Authorized Official - Last Name:LEACH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-368-8203
Mailing Address - Street 1:3602 E GREENWAY RD STE 104
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-4648
Mailing Address - Country:US
Mailing Address - Phone:602-368-8203
Mailing Address - Fax:
Practice Address - Street 1:215 S POWER RD STE 1251
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-5238
Practice Address - Country:US
Practice Address - Phone:602-368-4471
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-09
Last Update Date:2019-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZIFBH9439OtherARIZONA DEPARTMENT OF HEALTH LICENSE