Provider Demographics
NPI:1134322696
Name:CARE FIRST GROUP HOME
Entity Type:Organization
Organization Name:CARE FIRST GROUP HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DANIELA
Authorized Official - Middle Name:O
Authorized Official - Last Name:MICULA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-367-6491
Mailing Address - Street 1:12502 W. REDFIELD ROAD
Mailing Address - Street 2:
Mailing Address - City:EL MIRAGE
Mailing Address - State:AZ
Mailing Address - Zip Code:85335
Mailing Address - Country:US
Mailing Address - Phone:602-367-6491
Mailing Address - Fax:
Practice Address - Street 1:12502 W REDFIELD RD
Practice Address - Street 2:
Practice Address - City:EL MIRAGE
Practice Address - State:AZ
Practice Address - Zip Code:85335-5925
Practice Address - Country:US
Practice Address - Phone:602-367-6491
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-11
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZALH-4709310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility