Provider Demographics
NPI:1720363419
Name:ASCENIO FAMILY HOME CARE
Entity Type:Organization
Organization Name:ASCENIO FAMILY HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RENE
Authorized Official - Middle Name:
Authorized Official - Last Name:ASCENCIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-444-2289
Mailing Address - Street 1:23248 W YAVAPAI ST
Mailing Address - Street 2:
Mailing Address - City:BUCKEYE
Mailing Address - State:AZ
Mailing Address - Zip Code:85326-6181
Mailing Address - Country:US
Mailing Address - Phone:623-444-2289
Mailing Address - Fax:623-742-3818
Practice Address - Street 1:23248 W YAVAPAI ST
Practice Address - Street 2:
Practice Address - City:BUCKEYE
Practice Address - State:AZ
Practice Address - Zip Code:85326-6181
Practice Address - Country:US
Practice Address - Phone:623-444-2289
Practice Address - Fax:623-742-3818
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-13
Last Update Date:2011-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care