Provider Demographics
NPI:1609376474
Name:ALIGN GROUP HOME LLC
Entity Type:Organization
Organization Name:ALIGN GROUP HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:NKWANYUO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-753-4733
Mailing Address - Street 1:1460 E BAKER DR
Mailing Address - Street 2:
Mailing Address - City:SAN TAN VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85140-4016
Mailing Address - Country:US
Mailing Address - Phone:602-753-4733
Mailing Address - Fax:
Practice Address - Street 1:1460 E BAKER DR
Practice Address - Street 2:
Practice Address - City:SAN TAN VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85140-4016
Practice Address - Country:US
Practice Address - Phone:602-753-4733
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-18
Last Update Date:2018-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health