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HERITAGE LANE BEHAVIORAL ASSISTED LIVING
NPI 1053615906
Assisted Living Facility - Assisted Living, Mental Illness in Mesa, AZ

Active since January 07, 2011CLIA 03D1101539 · Waiver
1040 S LEBARON, MESA, AZ 85210(480) 307-8809(480) 781-0019 Get Directions Write a Review

NPPES record last updated: May 5, 2022. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Heritage Lane Behavioral Assisted Living NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

HERITAGE LANE BEHAVIORAL ASSISTED LIVING (NPI 1053615906) is a healthcare organization registered as an assisted living, mental illness in Mesa, Arizona and active in the NPI registry since January 2011. The organization holds a CLIA Waiver certificate valid through June 28, 2027 and lists Reed T Gunnell, Owner, as its authorized official.

NPPES Registry Identity

NPI1053615906
Entity TypeOrganization
Primary Taxonomy3104A0625X
Legal Business NameHERITAGE LIFE CENTER LLC
Location Address1040 S LEBARONMesa, AZ 85210-3631
Mailing Address1040 S LebaronMesa, AZ 85210-3631 · (480) 307-8809 · Fax (480) 307-8803
Phone(480) 307-8809
Fax(480) 781-0019
Organization SubpartNo
Authorized OfficialReed T GunnellOwner · (480) 307-8809
Enumeration DateJanuary 7, 2011
Last NPPES UpdateMay 5, 2022
NPPES CertifiedMay 5, 2022
✔ NPI 1053615906 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyAssisted Living Facility · Assisted Living, Mental IllnessNursing & Custodial Care Facilities
Taxonomy Code3104A0625X
Definition
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.
Also ListedAssisted Living FacilityTaxonomy 310400000X · License AL7718C (AZ)
1040 S LEBARON, Mesa, AZ 85210
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Other Names 1

Doing Business AsHeritage Lane Behavioral Assisted Living

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 03D1101539

Heritage Lane Behavioral Assisted Living · Mesa, AZ
Active · expires Jun 28, 2027
CLIA Number03D1101539
Laboratory TypeAssisted Living Facility
Certificate Effective DateJune 29, 2025
Certificate Expiration DateJune 28, 2027
Laboratory DirectorReed Gunnell
Laboratory Phone(480) 307-8809
Laboratory LocationHeritage Lane Behavioral Assisted Living1040 South Lebaron St, Mesa, AZ 85210
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Heritage Life Center LLC's NPI number?

The NPI number for Heritage Life Center LLC is 1053615906. It was assigned to this organization in the NPPES registry on January 7, 2011. The provider is doing business as Heritage Lane Behavioral Assisted Living.

Where is Heritage Life Center LLC located?

Heritage Life Center LLC is located at 1040 S Lebaron, Mesa, AZ 85210. The listed phone number is (480) 307-8809.

What is Heritage Life Center LLC's specialty?

The primary specialty registered for this NPI is Assisted Living Facility, specializing in Assisted Living, Mental Illness, with taxonomy code 3104A0625X.

Does Heritage Life Center LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 03D1101539) is associated with this NPI, valid through June 28, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Heritage Life Center LLC was last updated on May 5, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.