Sierra Vista Assistant Living LLC

Primary specialty

Intellectual and/or Developmental Disabilities Residential Treatment FacilityTaxonomy code 320600000X

License

AL8772H Issued in AZ

Legal business name

SIERRA VISTA ASSISTANT LIVING LLC

Practice address

3331 W Ian Dr
Laveen, AZ 85339-3805

Phone

(602) 628-3642

NPI assigned

Dec 29, 2012

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ms. Jia Seidel, MASTER DEGREE

Title

Owner/Manager

Phone

(602) 628-3642

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1356739200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1358812800000",
    "number": "1073859641",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3331 W IAN DR",
            "city": "LAVEEN",
            "state": "AZ",
            "postal_code": "853393805",
            "telephone_number": "602-628-3642"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3331 W IAN DR",
            "city": "LAVEEN",
            "state": "AZ",
            "postal_code": "853393805",
            "telephone_number": "602-628-3642"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SIERRA VISTA ASSISTANT LIVING LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-12-29",
        "last_updated": "2013-01-22",
        "status": "A",
        "authorized_official_last_name": "SEIDEL",
        "authorized_official_first_name": "JIA",
        "authorized_official_title_or_position": "OWNER/MANAGER",
        "authorized_official_telephone_number": "602-628-3642",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "MASTER DEGREE"
    },
    "taxonomies": [
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "AZ",
            "license": "AL8772H",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "10733859641",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Intellectual and/or Developmental Disabilities Residential Treatment Facility in Laveen, AZ
• Providers in Laveen, AZ by specialty
• Intellectual and/or Developmental Disabilities Residential Treatment Facility in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.