Organization
ILLUMINATED HEARTS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
REYNALDO MENDIBLES JR. (MEMBER/OWNER)
(520) 304-1502
Entity
Organization
Contact information
Practice address
7475 E RIO VISTA CIR, TUCSON, AZ 85715-3547
(520) 304-1502
Mailing address
7475 E RIO VISTA CIR, TUCSON, AZ 85715-3547
(520) 304-1502
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
AL12291H
ARIZONA HEALTH DEPARTMENT
AZ
Enumeration date
10/05/2022
Last updated
10/05/2022
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