Provider Demographics
NPI:1114599933
Name:MAXCARE GROUP HOMES LLC
Entity Type:Organization
Organization Name:MAXCARE GROUP HOMES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RON
Authorized Official - Middle Name:R
Authorized Official - Last Name:MOGAMBI-MARITA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-736-8264
Mailing Address - Street 1:45596 W WINDMILL DR
Mailing Address - Street 2:
Mailing Address - City:MARICOPA
Mailing Address - State:AZ
Mailing Address - Zip Code:85139-7091
Mailing Address - Country:US
Mailing Address - Phone:602-512-1338
Mailing Address - Fax:
Practice Address - Street 1:45596 W WINDMILL DR
Practice Address - Street 2:
Practice Address - City:MARICOPA
Practice Address - State:AZ
Practice Address - Zip Code:85139-7091
Practice Address - Country:US
Practice Address - Phone:602-512-1338
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-12
Last Update Date:2021-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility