Organization
ALPINE VILLA LLC
Active
Organization
ALPINE VILLA LLC
Active
Other names
Alpine Villa Luke
Organization subpart
No
Provider details
NPI number
Authorized official
ERIC GLADE MAUGHAN (ADMINISTRATOR/OWNER)
(602) 292-2010
Entity
Organization
Contact information
Practice address
2144 W LUKE AVE, PHOENIX, AZ 85015-2319
(602) 975-1700
Mailing address
8845 W POTTER DR, PEORIA, AZ 85382-6428
(602) 292-2010
Taxonomy
Speciality
Code
Description
License number
State
3104A0625X
Assisted Living Facility (Mental Illness)
—
—
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
06/11/2019
Last updated
10/21/2020
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