Provider Demographics
NPI:1316570260
Name:SHOW LOW ASSISTED LIVING LLC
Entity type:Organization
Organization Name:SHOW LOW ASSISTED LIVING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNTS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:MAYORAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-934-5600
Mailing Address - Street 1:PO BOX 47090
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85068-7090
Mailing Address - Country:US
Mailing Address - Phone:623-934-5600
Mailing Address - Fax:623-934-5603
Practice Address - Street 1:965 FULL HOUSE LN
Practice Address - Street 2:
Practice Address - City:SHOW LOW
Practice Address - State:AZ
Practice Address - Zip Code:85901-4044
Practice Address - Country:US
Practice Address - Phone:928-892-5139
Practice Address - Fax:928-251-0774
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-19
Last Update Date:2020-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility