Class Act Glencove Mesa, LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

CLASS ACT GLENCOVE MESA, LLC

Practice address

2156 E Glencove St
Mesa, AZ 85213-4611

Phone

(480) 464-9958

NPI assigned

Apr 29, 2019

Organization subpart

No

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

Authorized official

Name

Terrie Miller

Title

Member

Phone

(760) 408-4049

Specialties & licenses 1

Addresses

Other identifiers 2

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

{
    "created_epoch": "1556496000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1556496000000",
    "number": "1548824162",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2156 E GLENCOVE ST",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852134611"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2156 E GLENCOVE ST",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852134611",
            "telephone_number": "480-464-9958"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLASS ACT GLENCOVE MESA, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-04-29",
        "last_updated": "2019-04-29",
        "status": "A",
        "authorized_official_last_name": "MILLER",
        "authorized_official_first_name": "TERRIE",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "760-408-4049"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE NUMBER",
            "identifier": "AK1044OH",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AZAHCCCS",
            "identifier": "419737",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Romney Clark
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• Vargas L Clark, MS. ED
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• Class Act Los Alamos, LLC
• Class Act, Inc.
• Trey Clauser, PT, DPT
• Benjamin Claussen
• Courtney James Clawson, DO

• Assisted Living Facility in Mesa, AZ
• Providers in Mesa, AZ by specialty
• Assisted Living Facility in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 2019; 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.