Provider Demographics
NPI:1679920136
Name:LOS NINO'S DAY CARE OF CATALINA LLC
Entity Type:Organization
Organization Name:LOS NINO'S DAY CARE OF CATALINA LLC
Other - Org Name:MARY & PETE'S ASSISTED LIVING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:GONZALES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-400-4217
Mailing Address - Street 1:PO BOX 74
Mailing Address - Street 2:
Mailing Address - City:SAN MANUEL
Mailing Address - State:AZ
Mailing Address - Zip Code:85631-0074
Mailing Address - Country:US
Mailing Address - Phone:520-909-3241
Mailing Address - Fax:
Practice Address - Street 1:203 E AVENUE I
Practice Address - Street 2:
Practice Address - City:SAN MANUEL
Practice Address - State:AZ
Practice Address - Zip Code:85631-1357
Practice Address - Country:US
Practice Address - Phone:520-909-3241
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-15
Last Update Date:2016-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAL9394H310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ004189OtherAHCCCS