Third Street Home
Assisted Living Facility in Mesa, AZ. Organization (NPI-2).
NPI number1154511202
StatusActive
Last updated in NPPESJul 25, 2007
Details
- NPI
- 1154511202
- Entity type
- Organization (NPI-2)
- Legal business name
- Third Street Home
- Organization subpart
- No
- Enumeration date
- Jul 25, 2007
- Last updated
- Jul 25, 2007
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 310400000X | Assisted Living Facility | ALH-4846 | AZ | Yes |
| 311ZA0620X | Custodial Care Facility, Adult Care Home | ALH-4846 | AZ |
Practice location
1053 E 3rd StMesa, AZ 85203-8001
Phone 480-610-6974 · Fax 480-610-6974
Mailing address
1053 E 3rd StMesa, AZ 85203-8001
Phone 480-610-6974 · Fax 480-610-6974
Authorized official
Amalia Simona Bondar
Manager
4806106974
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