Provider Demographics
NPI:1114296332
Name:LIFE SONORAN HOMNES
Entity Type:Organization
Organization Name:LIFE SONORAN HOMNES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:
Authorized Official - Last Name:FITZGERALD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-650-6685
Mailing Address - Street 1:PO BOX 8998
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85214-8998
Mailing Address - Country:US
Mailing Address - Phone:480-650-6685
Mailing Address - Fax:480-461-0069
Practice Address - Street 1:2036 E CALLE MADERAS
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85213-2910
Practice Address - Country:US
Practice Address - Phone:480-650-6685
Practice Address - Fax:480-461-0069
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-16
Last Update Date:2011-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home