Organization
CLASS ACT GLENCOVE MESA, LLC
Active
Organization
CLASS ACT GLENCOVE MESA, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TERRIE MILLER (MEMBER)
(760) 408-4049
Entity
Organization
Contact information
Practice address
2156 E GLENCOVE ST, MESA, AZ 85213-4611
(480) 464-9958
Mailing address
2156 E GLENCOVE ST, MESA, AZ 85213-4611
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
419737
AZAHCCCS
AZ
01
—
AK1044OH
LICENSE NUMBER
AZ
Enumeration date
04/29/2019
Last updated
04/29/2019
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