Provider Demographics
NPI:1093357014
Name:HONOR ASSISTED LIVING LLC
Entity Type:Organization
Organization Name:HONOR ASSISTED LIVING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BEHROUZ
Authorized Official - Middle Name:
Authorized Official - Last Name:BARZANI
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:732-766-1099
Mailing Address - Street 1:24247 N 81ST ST
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85255-2808
Mailing Address - Country:US
Mailing Address - Phone:732-766-1099
Mailing Address - Fax:480-629-5544
Practice Address - Street 1:7412 E WETHERSFIELD RD
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-4719
Practice Address - Country:US
Practice Address - Phone:732-766-1099
Practice Address - Fax:480-629-5544
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-10
Last Update Date:2019-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ435193Medicaid