Provider Demographics
NPI:1699394858
Name:ACOME HOME LLC
Entity Type:Organization
Organization Name:ACOME HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MAFTEAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-266-2461
Mailing Address - Street 1:4509 E ACOMA DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-4855
Mailing Address - Country:US
Mailing Address - Phone:480-266-2461
Mailing Address - Fax:
Practice Address - Street 1:4509 E ACOMA DR
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-4855
Practice Address - Country:US
Practice Address - Phone:480-266-2461
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-08
Last Update Date:2020-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness