Provider Demographics
NPI:1518466903
Name:ARMS OF LOVE ASSISTED LIVING HOME LLC
Entity Type:Organization
Organization Name:ARMS OF LOVE ASSISTED LIVING HOME LLC
Other - Org Name:N/A
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMISTRATOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:GLADYS
Authorized Official - Middle Name:N/A
Authorized Official - Last Name:KWAMBOKA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-329-0820
Mailing Address - Street 1:6086 S PEARL DR
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85249-7090
Mailing Address - Country:US
Mailing Address - Phone:480-329-0820
Mailing Address - Fax:480-410-6757
Practice Address - Street 1:6086 S PEARL DRIVE
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85249
Practice Address - Country:US
Practice Address - Phone:480-329-0820
Practice Address - Fax:480-410-6757
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AL10575
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-02-12
Last Update Date:2018-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZD06903789Medicaid