Provider Demographics
NPI:1740045053
Name:DELIGHTFUL DOMICILE
Entity type:Organization
Organization Name:DELIGHTFUL DOMICILE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:GAD
Authorized Official - Middle Name:
Authorized Official - Last Name:SEZIRAHIGA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:160-263-2894
Mailing Address - Street 1:5312 E TAYLOR ST APT 252
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85008-6754
Mailing Address - Country:US
Mailing Address - Phone:160-263-2894
Mailing Address - Fax:
Practice Address - Street 1:2122 E HIGHLAND AVE STE 260
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-4779
Practice Address - Country:US
Practice Address - Phone:602-632-8943
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-15
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care