Provider Demographics
NPI:1487016820
Name:SAMARITAN ANGEL CARE SERVICES LLC
Entity Type:Organization
Organization Name:SAMARITAN ANGEL CARE SERVICES LLC
Other - Org Name:ASSISTED LIVING HOME
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AIMEE
Authorized Official - Middle Name:N
Authorized Official - Last Name:NYIRAKANYANA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-991-0001
Mailing Address - Street 1:6321 E EVANS DR
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-3219
Mailing Address - Country:US
Mailing Address - Phone:480-991-0001
Mailing Address - Fax:480-922-5229
Practice Address - Street 1:6321 E EVANS DR
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85254-3219
Practice Address - Country:US
Practice Address - Phone:480-991-0001
Practice Address - Fax:480-922-5229
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-24
Last Update Date:2016-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAL9984H385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care