Provider Demographics
NPI:1568156248
Name:CALEB HEALTHCARE LLC
Entity Type:Organization
Organization Name:CALEB HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:REGINA
Authorized Official - Middle Name:
Authorized Official - Last Name:MENSAH
Authorized Official - Suffix:
Authorized Official - Credentials:RN, MSN, MPHN
Authorized Official - Phone:623-628-3252
Mailing Address - Street 1:17148 W BUCHANAN ST
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85338-1285
Mailing Address - Country:US
Mailing Address - Phone:623-628-3252
Mailing Address - Fax:
Practice Address - Street 1:2827 W NORTHVIEW AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85051-7586
Practice Address - Country:US
Practice Address - Phone:623-628-3252
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-06
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness