Organization
HERITAGE VILLAGE BLDG2, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RON STEWART (MANAGER)
(253) 241-4992
Entity
Organization
Contact information
Practice address
8035 E BROWN RD, MESA, AZ 85207-3901
(480) 686-8540
Mailing address
2813 63RD AVENUE CT NW, GIG HARBOR, WA 98335-8455
(253) 241-4992
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
AL105345C
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
AL10534C
ASSISTED LIVING LICENSE
AZ
Enumeration date
10/03/2017
Last updated
10/03/2017
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