Provider Demographics
NPI:1114597804
Name:AHADI CARE HOME
Entity Type:Organization
Organization Name:AHADI CARE HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:WANJE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-659-7003
Mailing Address - Street 1:3459 E VAUGHN AVE
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85234-4247
Mailing Address - Country:US
Mailing Address - Phone:480-659-7003
Mailing Address - Fax:
Practice Address - Street 1:3459 E VAUGHN AVE
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234-4247
Practice Address - Country:US
Practice Address - Phone:480-659-7003
Practice Address - Fax:480-546-4317
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-25
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home