Provider Demographics
NPI:1457565699
Name:LEISURE LIVING
Entity Type:Organization
Organization Name:LEISURE LIVING
Other - Org Name:ENCANTO PLACE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CLINT
Authorized Official - Middle Name:C
Authorized Official - Last Name:ZIMMERMAN
Authorized Official - Suffix:II
Authorized Official - Credentials:MANAGER
Authorized Official - Phone:480-348-0759
Mailing Address - Street 1:8424 E VIA DE ENCANTO
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-3908
Mailing Address - Country:US
Mailing Address - Phone:480-348-0759
Mailing Address - Fax:480-348-1531
Practice Address - Street 1:8424 E VIA DE ENCANTO
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-3908
Practice Address - Country:US
Practice Address - Phone:480-348-0759
Practice Address - Fax:480-348-1531
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZALH3199310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility