Provider Demographics
NPI:1891060638
Name:VALLEY OF THE SUN ASSISTED LIVING HOME- EAST LLC
Entity Type:Organization
Organization Name:VALLEY OF THE SUN ASSISTED LIVING HOME- EAST LLC
Other - Org Name:VALLEY OF THE SUN ASSISTED LIVING FACILITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MIRNES
Authorized Official - Middle Name:
Authorized Official - Last Name:MEHIC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-720-4591
Mailing Address - Street 1:2018 E WAGONER RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85022-1433
Mailing Address - Country:US
Mailing Address - Phone:480-720-4591
Mailing Address - Fax:602-788-2245
Practice Address - Street 1:2018 E WAGONER RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85022-1433
Practice Address - Country:US
Practice Address - Phone:480-720-4591
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-13
Last Update Date:2012-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAL8565H311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home