412 S 30TH St LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

412 S 30TH ST LLC

Practice address

412 S 30TH St
Mesa, AZ 85204-3111

Phone

(480) 584-5666

Fax

(480) 588-5460

NPI assigned

Sep 5, 2023

Last updated

Sep 5, 2023By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Chaim Zimmerman

Title

Manager

Phone

(480) 584-5666

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1693872000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1693872000000",
    "number": "1821874934",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "412 S 30TH ST",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852043111",
            "telephone_number": "480-584-5666",
            "fax_number": "480-588-5460"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "412 S 30TH ST",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852043111",
            "telephone_number": "480-584-5666",
            "fax_number": "480-588-5460"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "412 S 30TH ST LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-09-05",
        "last_updated": "2023-09-05",
        "certification_date": "2023-09-05",
        "status": "A",
        "authorized_official_last_name": "ZIMMERMAN",
        "authorized_official_first_name": "CHAIM",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "480-584-5666"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 5, 2023; 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.