Provider Demographics
NPI:1790143527
Name:MARGAT,LLC
Entity Type:Organization
Organization Name:MARGAT,LLC
Other - Org Name:PLESANT STAY CARE HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/MGR
Authorized Official - Prefix:
Authorized Official - First Name:MILA
Authorized Official - Middle Name:
Authorized Official - Last Name:MARCELO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-493-5182
Mailing Address - Street 1:3221 E PERSHING AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-6149
Mailing Address - Country:US
Mailing Address - Phone:602-493-5182
Mailing Address - Fax:602-992-7076
Practice Address - Street 1:3221 E PERSHING AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-6149
Practice Address - Country:US
Practice Address - Phone:602-493-5182
Practice Address - Fax:602-992-7076
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-08
Last Update Date:2016-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAL6914H172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172V00000XOther Service ProvidersCommunity Health WorkerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ554073Medicaid