Organization
LEGACY SENIOR MANAGEMENT LLC
Active
Other names
Copper Heights BH
Organization subpart
No
Provider details
NPI number
Authorized official
MARY GRACE LEACH (COE)
(602) 368-8203
Entity
Organization
Contact information
Practice address
152 N 56TH ST STE B, MESA, AZ 85205-8718
(480) 985-0680
(480) 396-6231
Mailing address
3602 E GREENWAY RD STE 104, PHOENIX, AZ 85032-4648
(602) 368-8203
(602) 368-8211
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
BH5449
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
BH5449
ARIZONA DEPARTMENT OF HEALTH SERVICES
AZ
Enumeration date
06/07/2018
Last updated
06/07/2018
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