Provider Demographics
NPI:1427355841
Name:VVV ADULT CARE
Entity type:Organization
Organization Name:VVV ADULT CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JUSTION
Authorized Official - Middle Name:
Authorized Official - Last Name:GARRET
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-907-6012
Mailing Address - Street 1:7116 E MEDINA AVE
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85209-4826
Mailing Address - Country:US
Mailing Address - Phone:480-907-6012
Mailing Address - Fax:480-588-5012
Practice Address - Street 1:7116 E MEDINA AVE
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85209-4826
Practice Address - Country:US
Practice Address - Phone:480-907-6012
Practice Address - Fax:480-588-5012
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EMILY'S PLACE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-02-21
Last Update Date:2011-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAL6800H310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ224861Medicaid