Provider Demographics
NPI:1609558881
Name:EMMANUEL CARE HOME INC.
Entity Type:Organization
Organization Name:EMMANUEL CARE HOME INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANGELO
Authorized Official - Middle Name:SOLON
Authorized Official - Last Name:TIRAMBULO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-748-8131
Mailing Address - Street 1:6414 E CALLE CAPPELA
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85710-5304
Mailing Address - Country:US
Mailing Address - Phone:520-748-8131
Mailing Address - Fax:520-790-5149
Practice Address - Street 1:6414 E CALLE CAPPELA
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85710-5304
Practice Address - Country:US
Practice Address - Phone:520-748-8131
Practice Address - Fax:520-790-5149
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EMMANUEL CARE HOME INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-08-07
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ428559Medicaid