Provider Demographics
NPI:1083018691
Name:COMFORT LIVING CARE HOME LLC
Entity Type:Organization
Organization Name:COMFORT LIVING CARE HOME LLC
Other - Org Name:COMFORT LIVING HOME CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATIVE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:DEL CARMEN
Authorized Official - Last Name:GARTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-390-2919
Mailing Address - Street 1:3304 N LOS ALTOS DR
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-1156
Mailing Address - Country:US
Mailing Address - Phone:480-284-7236
Mailing Address - Fax:480-284-7252
Practice Address - Street 1:3304 N LOS ALTOS DR
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-1156
Practice Address - Country:US
Practice Address - Phone:480-284-7236
Practice Address - Fax:480-284-7252
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-11
Last Update Date:2014-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAL9310H310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility