Provider Demographics
NPI: | 1982130126 |
---|---|
Name: | RESIDENTS AT THE HEIGHTS, LLC |
Entity Type: | Organization |
Organization Name: | RESIDENTS AT THE HEIGHTS, LLC |
Other - Org Name: | UNHOOKED RECOVERY MAIN STREET |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | CEO/OWNER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | MARY |
Authorized Official - Middle Name: | GRACE |
Authorized Official - Last Name: | LEACH |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 602-368-8203 |
Mailing Address - Street 1: | 215 S POWER RD STE 1251 |
Mailing Address - Street 2: | |
Mailing Address - City: | MESA |
Mailing Address - State: | AZ |
Mailing Address - Zip Code: | 85206-5238 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 602-368-4471 |
Mailing Address - Fax: | 602-368-8211 |
Practice Address - Street 1: | 5801 E MAIN ST |
Practice Address - Street 2: | |
Practice Address - City: | MESA |
Practice Address - State: | AZ |
Practice Address - Zip Code: | 85205-8851 |
Practice Address - Country: | US |
Practice Address - Phone: | 602-368-4471 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2017-05-09 |
Last Update Date: | 2020-12-07 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
AZ | OTC8147 | 251S00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 251S00000X | Agencies | Community/Behavioral Health |