Provider Demographics
NPI:1053430454
Name:ASSISTED LIVING AT MOUNTAIN VISTA
Entity type:Organization
Organization Name:ASSISTED LIVING AT MOUNTAIN VISTA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:BETH
Authorized Official - Middle Name:
Authorized Official - Last Name:GLOVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-441-2563
Mailing Address - Street 1:6501 E GREENWAY PKWY
Mailing Address - Street 2:SUITE 103-505
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-2065
Mailing Address - Country:US
Mailing Address - Phone:602-441-2563
Mailing Address - Fax:602-354-7129
Practice Address - Street 1:12823 N 65TH PL
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85254-4519
Practice Address - Country:US
Practice Address - Phone:602-441-2563
Practice Address - Fax:602-354-7129
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZALH-5146310400000X, 3104A0625X, 3104A0630X, 310500000X, 311ZA0620X, 323P00000X, 324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Not Answered3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness
Not Answered3104A0630XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Behavioral Disturbances
Not Answered310500000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Mental Illness
Not Answered311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Not Answered323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
Not Answered324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility