Provider Demographics
NPI:1659247435
Name:DIFFERENTLY ABLED CARE GROUP LLC
Entity type:Organization
Organization Name:DIFFERENTLY ABLED CARE GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NIKOL
Authorized Official - Middle Name:LYN
Authorized Official - Last Name:CASTRO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-462-8458
Mailing Address - Street 1:889 S 134TH PL
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85233-7746
Mailing Address - Country:US
Mailing Address - Phone:808-462-8458
Mailing Address - Fax:
Practice Address - Street 1:889 S 134TH PL
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85233-7746
Practice Address - Country:US
Practice Address - Phone:808-462-8458
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-10-16
Last Update Date:2025-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No385H00000XRespite Care FacilityRespite Care
No385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child