Organization
PAVILION GUEST HOME
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARIETA G. HUGO (OWNER)
(480) 654-8329
Entity
Organization
Contact information
Practice address
2955 E MALLORY ST, MESA, AZ 85213-1667
(480) 654-8329
(480) 830-4113
Mailing address
2955 E. MALLORY ST., MESA, AZ 85213
(480) 654-8329
(480) 830-4113
Taxonomy
Speciality
Code
Description
License number
State
311ZA0620X
Adult Care Home Facility
Primary
ALH 4489
AZ
Other
Enumeration date
01/30/2007
Last updated
08/22/2020
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