Organization
FOUNTAIN ASSISSTED LIVING CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KIRSTIN LUNDAHL (OWNER/BUSINESS MANAGER)
(480) 206-4241
Entity
Organization
Contact information
Practice address
2260 E BROWN ROAD, MESA, AZ 85213-5224
(480) 299-3310
Mailing address
3048 E BASELINE RD, STE 108, MESA, AZ 85204
(480) 206-4241
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
103616
—
AZ
Enumeration date
12/09/2020
Last updated
02/14/2025
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