Active NPI
Copper Village
Doing business as Legacy Senior Management LLC
- Assisted Living Facility
- Mesa, AZ
National Provider Identifier
1881833614
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Assisted Living Facility
- License
- ALC-5776
- Legal business name
- COPPER VILLAGE
- Doing business as
- Legacy Senior Management LLC
- Practice address
- 5037 E Broadway Rd
Mesa, AZ 85206-1301 - Phone
- (480) 924-4073
- Fax
- (480) 396-0191
- NPI assigned
- Feb 18, 2009
- Last updated
- Feb 18, 2009
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mr. Jason R Guinn
- Title
- A/R Coordinator
- Phone
- (602) 368-8203
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Assisted Living Facility | 310400000X | ALC-5776 | AZ | Primary |
Addresses
Primary practice location
5037 E Broadway Rd
Mesa, AZ 85206-1301
Mailing address
5037 E Broadway Rd
Mesa, AZ 85206-1301
Phone (480) 924-4073
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 099345 | Medicaid | AZ |
Other names 1
- Legacy Senior Management LLC
National Provider Directory
National Provider Directory- Tax ID family
- Copper Heights
Other organizations with this tax ID 3
Organizations that report the same tax identification number in the National Provider Directory.
-
dba Copper Heights BH
- Mental Illness Community Based Residential Treatment Facility
- Mesa, AZ
- NPI 1780177535
-
- Mental Illness Community Based Residential Treatment Facility
- Mesa, AZ
- NPI 1437377207
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1234915200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1234915200000",
"number": "1881833614",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5037 E BROADWAY RD",
"city": "MESA",
"state": "AZ",
"postal_code": "852061301",
"telephone_number": "480-924-4073",
"fax_number": "480-396-0191"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5037 E BROADWAY RD",
"city": "MESA",
"state": "AZ",
"postal_code": "852061301",
"telephone_number": "480-924-4073",
"fax_number": "480-396-0191"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "COPPER VILLAGE",
"organizational_subpart": "NO",
"enumeration_date": "2009-02-18",
"last_updated": "2009-02-18",
"status": "A",
"authorized_official_last_name": "GUINN",
"authorized_official_first_name": "JASON",
"authorized_official_middle_name": "R",
"authorized_official_title_or_position": "A/R COORDINATOR",
"authorized_official_telephone_number": "602-368-8203",
"authorized_official_name_prefix": "Mr."
},
"taxonomies": [
{
"code": "310400000X",
"taxonomy_group": "",
"desc": "Assisted Living Facility",
"state": "AZ",
"license": "ALC-5776",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "099345",
"state": "AZ"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Legacy Senior Management LLC",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Mesa, AZ
- Copper Star Medical Supply
- Copper State Counseling
- Copper State Hospital and Surgical
- Copper State Laboratory Services
- Copper Tree Health LLC (Copper Tree Primary Care)
- Mark Coppers, LPC
- Robert J. Coppola, DO
- Sofia Rita Coracides, PHARMD
- Corazon Cardiac & Vascular Institute, PLLC
- Daniel M Corcoran, DVM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 18, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.