Provider Demographics
NPI:1619148509
Name:SUSAN'S ADULT CARE, LLC
Entity Type:Organization
Organization Name:SUSAN'S ADULT CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:LORI
Authorized Official - Last Name:NERHEIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-998-7840
Mailing Address - Street 1:6722 E CAMINO DE LOS RANCHOS
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-3908
Mailing Address - Country:US
Mailing Address - Phone:480-998-7840
Mailing Address - Fax:480-219-0464
Practice Address - Street 1:6722 E CAMINO DE LOS RANCHOS
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85254-3908
Practice Address - Country:US
Practice Address - Phone:480-998-7840
Practice Address - Fax:480-219-0464
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-18
Last Update Date:2008-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZALH4544311ZA0620X
AZALH4915311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home