Provider Demographics
NPI:1376320374
Name:MARYS GROUP HOME LLC
Entity Type:Organization
Organization Name:MARYS GROUP HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MAIRELIS
Authorized Official - Middle Name:
Authorized Official - Last Name:ZALDIVAR-SALAZAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-621-2931
Mailing Address - Street 1:10008 W BLOCH RD
Mailing Address - Street 2:
Mailing Address - City:TOLLESON
Mailing Address - State:AZ
Mailing Address - Zip Code:85353-4446
Mailing Address - Country:US
Mailing Address - Phone:602-621-2931
Mailing Address - Fax:623-398-8666
Practice Address - Street 1:10008 W BLOCH RD
Practice Address - Street 2:
Practice Address - City:TOLLESON
Practice Address - State:AZ
Practice Address - Zip Code:85353-4446
Practice Address - Country:US
Practice Address - Phone:602-621-2931
Practice Address - Fax:623-398-8666
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-12
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility