Provider Demographics
NPI:1083228316
Name:UNIQUE FAMILY TO FAMILY ADULT CARE HOME, LLC
Entity Type:Organization
Organization Name:UNIQUE FAMILY TO FAMILY ADULT CARE HOME, LLC
Other - Org Name:VILLA HERMOSA ASSISTED LIVING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KIRSTEN
Authorized Official - Middle Name:
Authorized Official - Last Name:CARR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:623-252-5690
Mailing Address - Street 1:6981 W VILLA HERMOSA
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85310-5855
Mailing Address - Country:US
Mailing Address - Phone:623-252-5690
Mailing Address - Fax:
Practice Address - Street 1:6981 W VILLA HERMOSA
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85310-5855
Practice Address - Country:US
Practice Address - Phone:623-252-5690
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-03
Last Update Date:2021-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness