Provider Demographics
NPI:1710158878
Name:CARRIAGE ASSISTED LIVING HOME
Entity Type:Organization
Organization Name:CARRIAGE ASSISTED LIVING HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LUZ
Authorized Official - Middle Name:M
Authorized Official - Last Name:DE VERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-350-7355
Mailing Address - Street 1:3352 N CARRIAGE LN
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-1107
Mailing Address - Country:US
Mailing Address - Phone:480-350-7355
Mailing Address - Fax:480-350-7355
Practice Address - Street 1:3352 N CARRIAGE LN
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-1107
Practice Address - Country:US
Practice Address - Phone:480-350-7355
Practice Address - Fax:480-350-7355
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-17
Last Update Date:2008-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZALH-5803310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility