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Organization

ACTIVE ASSISTED LIVING, LLC

Active
Other names
Comfort Haven of Mesa
Organization subpart
No

Provider details

NPI number
Authorized official
MR. STEVEN JAMES THARALSON (DIRECTOR)
(480) 461-8272
Entity
Organization

Contact information

Practice address
758 S TOLTEC, MESA, AZ 85204-3642
(480) 461-8272
(480) 461-4682
Mailing address
1235 S GILBERT RD, STE 3, PMB 83, MESA, AZ 85204-6005
(480) 461-8272
(480) 461-4682

Taxonomy

Speciality
Code
Description
License number
State
320700000X
Physical Disabilities Residential Treatment Facility
Primary
ALH-4567
AZ

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
ALH-4567
ASSISTED LIVING LICENSE
AZ
Enumeration date
03/30/2007
Last updated
08/01/2007
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