Provider Demographics
NPI:1003595620
Name:AZARA HOME PLUS LLC
Entity Type:Organization
Organization Name:AZARA HOME PLUS LLC
Other - Org Name:AZARA HOME PLUS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JERONE
Authorized Official - Middle Name:DEVON
Authorized Official - Last Name:HUNTER
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:316-633-2412
Mailing Address - Street 1:5120 E CENTRAL AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67208-4168
Mailing Address - Country:US
Mailing Address - Phone:316-633-2412
Mailing Address - Fax:
Practice Address - Street 1:2501 N ROOSEVELT COURT
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67220
Practice Address - Country:US
Practice Address - Phone:316-330-7373
Practice Address - Fax:316-665-7255
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-12
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home