Organization
AVISTA SENIOR LIVING VITA BELLA, LLC
Active
Organization
AVISTA SENIOR LIVING VITA BELLA, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. KRISTOPHER L WOOLLEY (MANAGING MEMBER)
(602) 628-5900
Entity
Organization
Contact information
Practice address
248 N MACDONALD, MESA, AZ 85201-6651
(480) 964-6685
Mailing address
1725 S COUNTRY CLUB DR, MESA, AZ 85210-6003
Taxonomy
Speciality
Code
Description
License number
State
261QH0100X
Health Service Clinic/Center
Primary
—
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
AL8507C
—
AZ
Enumeration date
08/09/2011
Last updated
08/09/2011
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