ACTIVE ASSISTED LIVING, LLC (NPI# 1629198858) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1629198858 |
| Entity Type | Organization |
| Organization Name | ACTIVE ASSISTED LIVING, LLC |
| Other Organization Name | COMFORT HAVEN OF MESA |
| Practice Address |
758 S Toltec Mesa AZ 85204-3642 |
| Mailing Address |
1235 S Gilbert Rd Ste 3, Pmb 83 Mesa AZ 85204-6005 |
| Practice Telephone | 4804618272 |
| Practice Fax Number | 4804614682 |
| Mailing Telephone | 4804618272 |
| Mailing Fax Number | 4804614682 |
| Enumeration Date | 2007-03-30 |
| Last Update Date | 2007-08-01 |
| Authorized Official Name | MR. STEVEN JAMES THARALSON (DIRECTOR) |
| Authorized Official Telephone | 4804618272 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 320700000X | Residential Treatment Facility, Physical Disabilities | ALH-4567 | AZ | Residential Treatment Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| AZ | ASSISTED LIVING LICENSE | ALH-4567 | 01 |
| Other Name | Type Code |
|---|---|
| Comfort Haven of Mesa | Doing Business As Name - Organization |
| Street Address |
758 S TOLTEC |
| City | MESA |
| State | AZ |
| Zip Code | 85204-3642 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194374819 | Luminations Healing Center, LLC | Social Worker | 1237 S. Val Vista Dr. #221, Mesa, AZ 85204 | 2019-09-05 |
| 1881160356 | Wanjiru Landers | Student in an Organized Health Care Education/Training Program | 550 S Linda Circle, Mesa, AZ 85204 | 2018-10-22 |
| 1649754235 | Adam Desnous | Specialist/Technologist | 751 S Daley, Mesa, AZ 85204 | 2018-09-19 |
| 1982128187 | Michael Anthony Jones | Counselor | 1107 North Gilbert Rd, Mesa, AZ 85204 | 2017-07-29 |
| 1295287225 | Scottsdale Healthcare Corp | Family Medicine | 2530 W. Southern Ave, Mesa, AZ 85204 | 2016-10-25 |
| 1427504158 | Richard White | Physician Assistant | 2345 E Southern Ave # 101, Mesa, AZ 85204 | 2016-09-01 |
| 1548716780 | Pain Stop Accident Injury LLC | Chiropractor | 425 E 11th Ave, Mesa, AZ 85204 | 2016-08-28 |
| 1154704252 | Glenn Taylor Lesueur | Dentist | 1056 S. Val Vista Dr., Suite 1, Mesa, AZ 85204 | 2015-07-07 |
| 1073932513 | Naomi Devine | Nurse Practitioner | 1840 South Stapley Drive, Suite 101, Mesa, AZ 85204 | 2014-04-14 |
| 1609292531 | John Kamau | Counselor | 1060 S Lobin Ln, Mesa, AZ 85204 | 2014-03-17 |
| Find all providers in zip 85204 | ||||
| Taxonomy Code | 320700000X |
| Grouping | Residential Treatment Facilities |
| Classification | Residential Treatment Facility, Physical Disabilities |
| A residential facility that provides habilitation services and other care and treatment to adults or children diagnosed with developmental disabilities and/or mental retardation and are not able to live independently. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073147195 | Armada Group-az, LLC | Residential Treatment Facility, Physical Disabilities | 1612 E. Knoll Circle, Mesa, AZ 85203 | 2020-02-27 |
| 1376981928 | Health Care Alternatives, Inc. | Residential Treatment Facility, Physical Disabilities | 532 W Nido Ave, Mesa, AZ 85210-7572 | 2013-06-05 |
| 1801234455 | Health Care Alternatives, Inc. | Residential Treatment Facility, Physical Disabilities | 2613 N Robin Cir, Mesa, AZ 85213-1610 | 2013-06-05 |
| 1659719201 | Health Care Alternatives, Inc. | Residential Treatment Facility, Physical Disabilities | 2110 N Lazona Dr, Mesa, AZ 85203-2020 | 2013-06-05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427656651 | Serenity Home Care LLC | Residential Treatment Facility, Physical Disabilities | 6858 S 19th St, Phoenix, AZ 85042-5770 | 2020-10-10 |
| 1497385892 | Serenity Home Care LLC | Residential Treatment Facility, Physical Disabilities | 4451 W St Anne Ave, Laveen, AZ 85339-6232 | 2020-01-24 |
| 1023658127 | Carefree Manor Assisted Living LLC | Residential Treatment Facility, Physical Disabilities | 7886 E Breathless Dr, Carefree, AZ 85377 | 2020-01-07 |
| 1497234710 | Sampaguita D. Maglalang | Residential Treatment Facility, Physical Disabilities | My Home Care Adult Assisted Living Facility, LLC., 2607 West Curry Street, Chandler, AZ 85224-1040 | 2018-08-08 |
| 1326533407 | Neuro Rehabcare Scottsdale - Az LLC | Residential Treatment Facility, Physical Disabilities | 7480 E Camino Santo, Scottsdale, AZ 85260-3905 | 2018-06-29 |
| 1356853915 | Pastalino Manor 4 | Residential Treatment Facility, Physical Disabilities | 1421 E Maldonado Dr, Phoenix, AZ 85042-5602 | 2017-11-03 |
| 1770009219 | Neuro Rehabcare of The Valley - Az LLC | Residential Treatment Facility, Physical Disabilities | 8307 W Misty Willow Ln, Peoria, AZ 85383-1511 | 2017-08-16 |
| 1184150484 | Ndg Adult Care Home LLC | Residential Treatment Facility, Physical Disabilities | 1106 W 9th St, Tempe, AZ 85281-5304 | 2017-05-04 |
| 1194198697 | Amanda Ellis | Residential Treatment Facility, Physical Disabilities | 381 East Brook Street, San Tan Valley, AZ 85140 | 2015-11-05 |
| 1447658943 | Moses Behavioral Care | Residential Treatment Facility, Physical Disabilities | 17622 W Port Royale Ln, Surprise, AZ 85388-7792 | 2014-12-15 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.