Provider Demographics
NPI:1326765165
Name:EZDONICE CARE LLC
Entity Type:Organization
Organization Name:EZDONICE CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:BRUNO
Authorized Official - Middle Name:
Authorized Official - Last Name:EZEALAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-650-2431
Mailing Address - Street 1:1601 W MUSKET WAY
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85286-8405
Mailing Address - Country:US
Mailing Address - Phone:480-650-2431
Mailing Address - Fax:
Practice Address - Street 1:4638 E SUMMERHAVEN DR
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85044-4820
Practice Address - Country:US
Practice Address - Phone:480-650-2431
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-24
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0630XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Behavioral Disturbances