Provider Demographics
NPI:1518312206
Name:HK KASIO LLC
Entity Type:Organization
Organization Name:HK KASIO LLC
Other - Org Name:RHODA'S ASSISTED LIVING HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HUSNUL
Authorized Official - Middle Name:KHOIRODAH
Authorized Official - Last Name:BOCCHINO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-487-6389
Mailing Address - Street 1:12002 W SHERIDAN ST
Mailing Address - Street 2:
Mailing Address - City:AVONDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85392-3078
Mailing Address - Country:US
Mailing Address - Phone:602-487-6389
Mailing Address - Fax:602-997-3205
Practice Address - Street 1:12002 W SHERIDAN ST
Practice Address - Street 2:
Practice Address - City:AVONDALE
Practice Address - State:AZ
Practice Address - Zip Code:85392-3078
Practice Address - Country:US
Practice Address - Phone:602-487-6389
Practice Address - Fax:602-997-3205
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RHODA'S ASSISTED LIVING HOME
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-04-30
Last Update Date:2016-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAL9839H311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home