NPI: 1144452988
Provider Name: HERITAGE LIFE CENTER LLC
Doing Business As: HERITAGE LANE BEHAVIORAL ASSISTED LIVING
Classification: Assisted Living Facility - 3104A0625X
Entity Type: Organization
Specialization: Assisted Living, Mental Illness
CLIA Number: 03D1101539
Address:
1041 S LEBARON
MESA, AZ
ZIP 85210
Phone: (480) 307-8809
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HERITAGE LIFE CENTER LLC is an assisted living and mental illness assisted living facility in Mesa, AZ. The provider is a facility providing supportive services to individuals who can function independently in most areas of activity, but need special guidance, assistance and/or monitoring as the result of a psychiatric problem. This type of facility requires a staff with special training in mental health training and dealing with psychiatric emergencies. HERITAGE LIFE CENTER LLC NPI is 1144452988. The provider is registered as an organization entity type.
The provider Is Doing Business As Heritage Lane Behavioral Assisted Living.
The provider's business location address is:
1041 S LEBARON
MESA, AZ
ZIP 85210-630
Phone: (480) 307-8809
Fax: (480) 781-0019
The provider's authorized official is Reed T Gunnell .
The authorized official title is Owner and has the following contact phone number (480) 307-8809.
The CLIA number assigned to this NPI record is 03D1101539 - assisted living facility with a certificate type of Certificate of Waiver.
The enumeration date for this NPI number is 8/12/2009 and was last updated on 5/5/2022.