Organization
SIERRA VISTA ASSISTANT LIVING LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. JIA SEIDEL MASTER DEGREE (OWNER/MANAGER)
(602) 628-3642
Entity
Organization
Contact information
Practice address
3331 W IAN DR, LAVEEN, AZ 85339-3805
(602) 628-3642
Mailing address
3331 W IAN DR, LAVEEN, AZ 85339-3805
(602) 628-3642
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
AL8772H
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10733859641
—
AZ
Enumeration date
12/29/2012
Last updated
01/22/2013
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