Provider Demographics
NPI:1669193678
Name:CRISMON PEAKS ASSISTED LIVING, LLC
Entity type:Organization
Organization Name:CRISMON PEAKS ASSISTED LIVING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:CHAIM
Authorized Official - Middle Name:
Authorized Official - Last Name:ZIMMERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-354-1006
Mailing Address - Street 1:10027 E HILLVIEW ST
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85207-4143
Mailing Address - Country:US
Mailing Address - Phone:480-354-1006
Mailing Address - Fax:480-380-3095
Practice Address - Street 1:10027 E HILLVIEW ST
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85207-4143
Practice Address - Country:US
Practice Address - Phone:480-354-1006
Practice Address - Fax:480-380-3095
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-07
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376G00000XNursing Service Related ProvidersNursing Home AdministratorGroup - Single Specialty