NPIMap

Organization Active NPI

Heritage Life Center LLC

Doing business as Heritage Lane Behavioral Assisted Living

  • Assisted Living Facility (Mental Illness)
  • Mesa, AZ
National Provider Identifier
1144452988
Registry record updated May 5, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Assisted Living Facility (Mental Illness)Taxonomy code 3104A0625X
Legal business name
HERITAGE LIFE CENTER LLC
Doing business as
Heritage Lane Behavioral Assisted Living
Practice address
1041 S Lebaron
Mesa, AZ 85210-3630
Phone
(480) 307-8809
Fax
(480) 781-0019
NPI assigned
Aug 12, 2009
Last updated
May 5, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 5, 2022

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

Authorized official

Name
Mr. Reed T Gunnell
Title
Owner
Phone
(480) 307-8809

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Assisted Living Facility (Mental Illness) 3104A0625X NU Primary

Addresses

Primary practice location

1041 S Lebaron
Mesa, AZ 85210-3630

Mailing address

1041 S Lebaron
Mesa, AZ 85210-3630
Phone (480) 307-8809

Other names 1

  • Heritage Lane Behavioral Assisted Living Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Heritage Lane Behavioral Assisted Living2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1041 S Lebaron
Mesa, AZ 85210
Phone (480) 307-8809

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1250035200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1651708800000",
    "number": "1144452988",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1041 S LEBARON",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852103630",
            "telephone_number": "480-307-8809",
            "fax_number": "480-307-8949"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1041 S LEBARON",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852103630",
            "telephone_number": "480-307-8809",
            "fax_number": "480-781-0019"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HERITAGE LIFE CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-08-12",
        "last_updated": "2022-05-05",
        "certification_date": "2022-05-05",
        "status": "A",
        "authorized_official_last_name": "GUNNELL",
        "authorized_official_first_name": "REED",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "480-307-8809",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "3104A0625X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility, Assisted Living, Mental Illness",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Heritage Lane Behavioral Assisted Living",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mesa, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 5, 2022; 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.