Provider Demographics
NPI:1346755907
Name:IRENE'S CARE HOME
Entity Type:Organization
Organization Name:IRENE'S CARE HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:IRENE
Authorized Official - Middle Name:T
Authorized Official - Last Name:KAMARA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-812-5540
Mailing Address - Street 1:10433 W MAGNOLIA ST
Mailing Address - Street 2:
Mailing Address - City:TOLLESON
Mailing Address - State:AZ
Mailing Address - Zip Code:85353-1264
Mailing Address - Country:US
Mailing Address - Phone:480-812-5540
Mailing Address - Fax:623-312-2833
Practice Address - Street 1:10433 W MAGNOLIA ST
Practice Address - Street 2:
Practice Address - City:TOLLESON
Practice Address - State:AZ
Practice Address - Zip Code:85353-1264
Practice Address - Country:US
Practice Address - Phone:480-812-5540
Practice Address - Fax:623-312-2833
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-05
Last Update Date:2017-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health