Provider Demographics
NPI:1417747429
Name:INGE'S UNIQUELY WARM ASSISTED LIVING LLC
Entity type:Organization
Organization Name:INGE'S UNIQUELY WARM ASSISTED LIVING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:MATTHEW
Authorized Official - Last Name:WEAKS
Authorized Official - Suffix:
Authorized Official - Credentials:MANAGER
Authorized Official - Phone:503-607-4519
Mailing Address - Street 1:1620 N 25TH PL
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85008-3515
Mailing Address - Country:US
Mailing Address - Phone:503-607-4519
Mailing Address - Fax:
Practice Address - Street 1:1625 S SULLIVAN LN
Practice Address - Street 2:
Practice Address - City:CAMP VERDE
Practice Address - State:AZ
Practice Address - Zip Code:86322-6871
Practice Address - Country:US
Practice Address - Phone:503-607-4519
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-12
Last Update Date:2025-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility