Provider Demographics
NPI:1750915872
Name:VIEW POINT FAIRMONT VILLAGE LLC
Entity type:Organization
Organization Name:VIEW POINT FAIRMONT VILLAGE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MOCKBEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-526-8600
Mailing Address - Street 1:10401 N 79TH AVE
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85345-0742
Mailing Address - Country:US
Mailing Address - Phone:623-526-8600
Mailing Address - Fax:
Practice Address - Street 1:10401 N 79TH AVE
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85345-0742
Practice Address - Country:US
Practice Address - Phone:623-526-8600
Practice Address - Fax:623-533-5399
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-27
Last Update Date:2020-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAL11352COtherARIZONA DEPARTMENT OF HEALTH SERVICES