Provider Demographics
NPI:1376854216
Name:ARK ASSISTED LIVING HOME, LLC
Entity Type:Organization
Organization Name:ARK ASSISTED LIVING HOME, LLC
Other - Org Name:ARK ASSISTED LIVING HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MINUROKH
Authorized Official - Middle Name:
Authorized Official - Last Name:MOHAJER-JASBI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-661-4331
Mailing Address - Street 1:9751 E BECKER LN
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-6205
Mailing Address - Country:US
Mailing Address - Phone:480-661-4331
Mailing Address - Fax:480-661-4331
Practice Address - Street 1:9751 E BECKER LN
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-6205
Practice Address - Country:US
Practice Address - Phone:480-661-4331
Practice Address - Fax:480-661-4331
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-25
Last Update Date:2010-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAL7848H310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility