Provider Demographics
NPI:1881209583
Name:ALPINE VILLA GROUP LLC
Entity Type:Organization
Organization Name:ALPINE VILLA GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:GLADE
Authorized Official - Last Name:MAUGHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-292-2010
Mailing Address - Street 1:8845 W POTTER DR
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85382-6428
Mailing Address - Country:US
Mailing Address - Phone:602-292-2010
Mailing Address - Fax:
Practice Address - Street 1:8845 W POTTER DR
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85382-6428
Practice Address - Country:US
Practice Address - Phone:602-292-2010
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-10
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health