Provider Demographics
NPI:1174003214
Name:A HOME FOR CARE LLC
Entity Type:Organization
Organization Name:A HOME FOR CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MEDARDO
Authorized Official - Middle Name:
Authorized Official - Last Name:ALEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-236-3959
Mailing Address - Street 1:25548 W DUNLAP RD
Mailing Address - Street 2:
Mailing Address - City:BUCKEYE
Mailing Address - State:AZ
Mailing Address - Zip Code:85326-9143
Mailing Address - Country:US
Mailing Address - Phone:520-858-3361
Mailing Address - Fax:623-223-9563
Practice Address - Street 1:25548 W DUNLAP RD
Practice Address - Street 2:
Practice Address - City:BUCKEYE
Practice Address - State:AZ
Practice Address - Zip Code:85326-9143
Practice Address - Country:US
Practice Address - Phone:520-858-3361
Practice Address - Fax:623-223-9563
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-17
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAL9703H310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ028336Medicaid