Organization · NPI-2

412 S 30th St LLC

Assisted Living Facility · Mesa, AZ

NPI number1821874934
StatusActive
Last updated in NPPESSep 5, 2023

Details

NPI
1821874934
Entity type
Organization (NPI-2)
Legal business name
412 S 30th St LLC
Organization subpart
No
Enumeration date
Sep 5, 2023
Certification date
Sep 5, 2023
Last updated
Sep 5, 2023

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
310400000X Assisted Living Facility––Yes

Practice location

412 S 30th St
Mesa, AZ 85204-3111

Phone 480-584-5666 · Fax 480-588-5460

Mailing address

412 S 30th St
Mesa, AZ 85204-3111

Phone 480-584-5666 · Fax 480-588-5460

Authorized official

Chaim Zimmerman
Manager
4805845666

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