Organization
GOLDWATER LEGACY ASSISTED LIVING LLC
Active
Organization
GOLDWATER LEGACY ASSISTED LIVING LLC
Active
Other names
GOLD WATER ASSISTED LIVING II
Organization subpart
No
Provider details
NPI number
Authorized official
STEPHEN TOHATAN (ADMINISTRATOR)
(480) 544-9334
Entity
Organization
Contact information
Practice address
6640 W PINNACLE PEAK RD, GLENDALE, AZ 85310-3409
(480) 544-9334
Mailing address
6640 W PINNACLE PEAK RD, GLENDALE, AZ 85310-3409
(480) 544-9334
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
AL9797H
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0
PRIVATE PAY
—
Enumeration date
06/06/2018
Last updated
06/16/2018
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