Provider Demographics
NPI:1356502454
Name:ASSISTED LIVING AT MOUNTAIN VISTA 1, INC.
Entity type:Organization
Organization Name:ASSISTED LIVING AT MOUNTAIN VISTA 1, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ZANELY
Authorized Official - Middle Name:ROXAS
Authorized Official - Last Name:ZARAGOZA
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:480-580-1650
Mailing Address - Street 1:6501 E GREENWAY PKWY
Mailing Address - Street 2:103-505
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-2065
Mailing Address - Country:US
Mailing Address - Phone:480-580-1650
Mailing Address - Fax:480-607-5444
Practice Address - Street 1:7568 N MOCKINGBIRD LN
Practice Address - Street 2:
Practice Address - City:PARADISE VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85253-3125
Practice Address - Country:US
Practice Address - Phone:480-699-7561
Practice Address - Fax:480-607-5444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-20
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZALH-62763104A0630X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0630XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Behavioral Disturbances