Provider Demographics
NPI:1518650704
Name:COMPREHENSIVE GROUP HOME LLC
Entity Type:Organization
Organization Name:COMPREHENSIVE GROUP HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:TESFAHUN
Authorized Official - Middle Name:WORKU
Authorized Official - Last Name:OUTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-585-7081
Mailing Address - Street 1:4628 W MAGDALENA LN
Mailing Address - Street 2:
Mailing Address - City:LAVEEN
Mailing Address - State:AZ
Mailing Address - Zip Code:85339-2353
Mailing Address - Country:US
Mailing Address - Phone:602-585-7091
Mailing Address - Fax:
Practice Address - Street 1:4628 W MAGDALENA LN
Practice Address - Street 2:
Practice Address - City:LAVEEN
Practice Address - State:AZ
Practice Address - Zip Code:85339-2353
Practice Address - Country:US
Practice Address - Phone:602-585-7091
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-01
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0630XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Behavioral Disturbances