Provider Demographics
NPI:1649930793
Name:HAPPY VALLEY RESIDENTIAL LLC
Entity type:Organization
Organization Name:HAPPY VALLEY RESIDENTIAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ESPERANCE
Authorized Official - Middle Name:
Authorized Official - Last Name:MAPENDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-630-1715
Mailing Address - Street 1:23157 N 103RD LN
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85383-2753
Mailing Address - Country:US
Mailing Address - Phone:949-630-1715
Mailing Address - Fax:
Practice Address - Street 1:23157 N 103RD LN
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85383-2753
Practice Address - Country:US
Practice Address - Phone:949-630-1715
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-29
Last Update Date:2021-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0630XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Behavioral Disturbances