Provider Demographics
NPI:1841565256
Name:APOLLO HEALTH CARE, INC.
Entity Type:Organization
Organization Name:APOLLO HEALTH CARE, INC.
Other - Org Name:APOLLO RESIDENTIAL PROGRAM
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT-CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:NELSON
Authorized Official - Last Name:JORGE
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:602-909-9026
Mailing Address - Street 1:2209 N RASCON LOOP
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85037-4357
Mailing Address - Country:US
Mailing Address - Phone:623-907-4678
Mailing Address - Fax:623-877-1155
Practice Address - Street 1:8322 W OREGON AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85305-3302
Practice Address - Country:US
Practice Address - Phone:623-877-0055
Practice Address - Fax:623-877-1155
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-19
Last Update Date:2012-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBH39893104A0625X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness