Organization
EVERGREEN AT MESA (ALF), L.L.C.
Active
Other names
Mesa Christian Residential Care Center
Organization subpart
No
Provider details
NPI number
Authorized official
MS. ANNE NIPP (MANAGER)
(360) 892-6618
Entity
Organization
Contact information
Practice address
215 W BROWN RD, MESA, AZ 85201-3415
(480) 668-6118
(480) 461-1552
Mailing address
215 W BROWN RD, MESA, AZ 85201-3415
(480) 668-6118
(480) 461-1552
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
ALC-5063
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
937427
—
AZ
Enumeration date
07/11/2007
Last updated
07/11/2007
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