Provider Demographics
NPI:1770829848
Name:HORIZON CARE HOME
Entity Type:Organization
Organization Name:HORIZON CARE HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MA GRACE CORAZON
Authorized Official - Middle Name:JUACHON
Authorized Official - Last Name:FERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-710-8782
Mailing Address - Street 1:10802 N 57TH DR
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85304-3864
Mailing Address - Country:US
Mailing Address - Phone:623-547-6699
Mailing Address - Fax:623-792-5698
Practice Address - Street 1:10802 N. 57TH DR
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85304-3867
Practice Address - Country:US
Practice Address - Phone:623-547-6699
Practice Address - Fax:623-792-5698
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-18
Last Update Date:2012-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAL8501H310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility