Provider Demographics
NPI:1811554074
Name:AZ COMFORT HOME, INC
Entity Type:Organization
Organization Name:AZ COMFORT HOME, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:OMIJIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-326-3327
Mailing Address - Street 1:18412 W MISSION LN
Mailing Address - Street 2:
Mailing Address - City:WADDELL
Mailing Address - State:AZ
Mailing Address - Zip Code:85355-4303
Mailing Address - Country:US
Mailing Address - Phone:623-326-3327
Mailing Address - Fax:623-321-1206
Practice Address - Street 1:16439 W COTTONWOOD ST
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85388-2160
Practice Address - Country:US
Practice Address - Phone:623-666-3895
Practice Address - Fax:623-321-1206
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AZ COMFORT HOME, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-05-23
Last Update Date:2019-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities