Heritage Village Bldg2, LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

AL105345C Issued in AZ

Legal business name

HERITAGE VILLAGE BLDG2, LLC

Practice address

8035 E Brown Rd
Mesa, AZ 85207-3901

Phone

(480) 686-8540

NPI assigned

Oct 3, 2017

Organization subpart

No

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

Authorized official

Name

Ron Stewart

Title

Manager

Phone

(253) 241-4992

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1506988800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1506988800000",
    "number": "1922518067",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2813 63RD AVENUE CT NW",
            "city": "GIG HARBOR",
            "state": "WA",
            "postal_code": "983358455",
            "telephone_number": "253-241-4992"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8035 E BROWN RD",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852073901",
            "telephone_number": "480-686-8540"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HERITAGE VILLAGE BLDG2, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-10-03",
        "last_updated": "2017-10-03",
        "status": "A",
        "authorized_official_last_name": "STEWART",
        "authorized_official_first_name": "RON",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "253-241-4992"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "AZ",
            "license": "AL105345C",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ASSISTED LIVING LICENSE",
            "identifier": "AL10534C",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Heritage Village 5 LLC
• Heritage Village 6 LLC
• Heritage Village BLDG 7
• Heritage Village BLDG 8 LLC
• Heritage Village Bldg1 LLC
• Heritage Village Bldg3, LLC
• Heritage Village Bldg5, LLC
• Heritage Village Bldg6, LLC
• Heritage Village Bldg9 LLC
• Heritage Village,5

• 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 Oct 3, 2017; 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.