Provider Demographics
NPI:1588656425
Name:DANIELA OZARCHEVICI
Entity Type:Organization
Organization Name:DANIELA OZARCHEVICI
Other - Org Name:FOUNTAIN OF YOUTH ADULT CARE HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DANIELA
Authorized Official - Middle Name:
Authorized Official - Last Name:OZARCHEVICI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-315-2951
Mailing Address - Street 1:1917 E PRESIDIO RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85022-5033
Mailing Address - Country:US
Mailing Address - Phone:480-383-3522
Mailing Address - Fax:480-747-9665
Practice Address - Street 1:1917 E PRESIDIO RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85022-5033
Practice Address - Country:US
Practice Address - Phone:480-383-3522
Practice Address - Fax:480-747-9665
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-17
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZALH-4698310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility