Provider Demographics
NPI:1023570355
Name:GIFTED HEARTS GROUP HOMES LLC
Entity Type:Organization
Organization Name:GIFTED HEARTS GROUP HOMES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREWS
Authorized Official - Middle Name:
Authorized Official - Last Name:SAMUKA
Authorized Official - Suffix:
Authorized Official - Credentials:BUSINESS OWNER
Authorized Official - Phone:928-257-7819
Mailing Address - Street 1:45763 W DIRK ST
Mailing Address - Street 2:
Mailing Address - City:MARICOPA
Mailing Address - State:AZ
Mailing Address - Zip Code:85139-6611
Mailing Address - Country:US
Mailing Address - Phone:602-303-8582
Mailing Address - Fax:
Practice Address - Street 1:45763 W DIRK ST
Practice Address - Street 2:
Practice Address - City:MARICOPA
Practice Address - State:AZ
Practice Address - Zip Code:85139-6611
Practice Address - Country:US
Practice Address - Phone:602-303-8582
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-04
Last Update Date:2019-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0630XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Behavioral Disturbances