Organization
COPPER VILLAGE
Active
Other names
Legacy Senior Management LLC
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JASON R GUINN (A/R COORDINATOR)
(602) 368-8203
Entity
Organization
Contact information
Practice address
5037 E BROADWAY RD, MESA, AZ 85206-1301
(480) 924-4073
(480) 396-0191
Mailing address
5037 E BROADWAY RD, MESA, AZ 85206-1301
(480) 924-4073
(480) 396-0191
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
ALC-5776
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
099345
—
AZ
Enumeration date
02/18/2009
Last updated
02/18/2009
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