Provider Demographics
NPI:1386274702
Name:ASSISTED LIVING OF PARADISE VALLEY LLC
Entity type:Organization
Organization Name:ASSISTED LIVING OF PARADISE VALLEY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:S
Authorized Official - Last Name:GIBSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-695-6890
Mailing Address - Street 1:6146 E VIA ESTRELLA AVE
Mailing Address - Street 2:
Mailing Address - City:PARADISE VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85253-1230
Mailing Address - Country:US
Mailing Address - Phone:480-695-6890
Mailing Address - Fax:480-443-9159
Practice Address - Street 1:6146 E VIA ESTRELLA AVE
Practice Address - Street 2:
Practice Address - City:PARADISE VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85253-1230
Practice Address - Country:US
Practice Address - Phone:480-695-6890
Practice Address - Fax:480-443-9159
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-24
Last Update Date:2020-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility