Provider Demographics
NPI:1508259953
Name:KOLA CARE, LLC
Entity Type:Organization
Organization Name:KOLA CARE, LLC
Other - Org Name:RIGHT AT HOME OF SOUTHERN ARIZONA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:L
Authorized Official - Last Name:BLISS
Authorized Official - Suffix:
Authorized Official - Credentials:MPA
Authorized Official - Phone:520-777-4175
Mailing Address - Street 1:7469 E BROADWAY BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85710-1487
Mailing Address - Country:US
Mailing Address - Phone:520-777-4175
Mailing Address - Fax:520-844-1198
Practice Address - Street 1:7469 E BROADWAY BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85710-1487
Practice Address - Country:US
Practice Address - Phone:520-777-4175
Practice Address - Fax:520-844-1198
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-10
Last Update Date:2015-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZNOT REQUIRED IN AZ253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care