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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