Organization
VISTA SOUTH ASSISTING LIVING
Active
Other names
Vista South Assisted Living
Organization subpart
No
Provider details
NPI number
Authorized official
KENNETH RAY THOMAS (OWNER)
(602) 435-3808
Entity
Organization
Contact information
Practice address
1010 E SOUTHERN AVE BLDG 2, PHOENIX, AZ 85040-5108
(602) 435-3808
(602) 276-1854
Mailing address
1010 E SOUTHERN AVE BLDG 2, PHOENIX, AZ 85040-5108
(602) 435-3808
(602) 276-1854
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
ALH5881
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
174413
—
AZ
Enumeration date
02/09/2007
Last updated
09/06/2023
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