Provider Demographics
NPI:1164576724
Name:ZAHRA C. M. PLAGENS
Entity Type:Organization
Organization Name:ZAHRA C. M. PLAGENS
Other - Org Name:MUTWOL FAMILY ADULT THERAPEUTIC FOSTER CARE
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ZAHRA
Authorized Official - Middle Name:CHEBET
Authorized Official - Last Name:PLAGENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-878-0463
Mailing Address - Street 1:7445 W CHERYL DR
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85345-6722
Mailing Address - Country:US
Mailing Address - Phone:623-878-0463
Mailing Address - Fax:
Practice Address - Street 1:7445 W CHERYL DR
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85345-6722
Practice Address - Country:US
Practice Address - Phone:623-878-0463
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2008-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBH25223104A0625X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ907305Medicaid
AZBH2522OtherSTATE LICENSE FOSTER CARE