Organization
PROVIDENCE LEGACY ASSISTED LIVING
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JINETTE LANOIX (OWNER/MANAGER)
(480) 388-1151
Entity
Organization
Contact information
Practice address
4812 E MEADOW MIST LN, QUEEN CREEK, AZ 85140-5222
(480) 388-1151
Mailing address
4812 E MEADOW MIST LN, QUEEN CREEK, AZ 85140-5222
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
AL7937
AZ
Other
Enumeration date
07/06/2010
Last updated
07/06/2010
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