Provider Demographics
NPI:1851801690
Name:RESCARE RESIDENTIAL SERVICES ARIZONA, LLC
Entity Type:Organization
Organization Name:RESCARE RESIDENTIAL SERVICES ARIZONA, LLC
Other - Org Name:A PLACE TO CALL HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARALEGAL
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:A
Authorized Official - Last Name:PANK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-420-2666
Mailing Address - Street 1:9901 LINN STATION RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40223-3808
Mailing Address - Country:US
Mailing Address - Phone:502-394-2100
Mailing Address - Fax:
Practice Address - Street 1:1830 S ALMA SCHOOL RD STE 122
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85210-3087
Practice Address - Country:US
Practice Address - Phone:480-456-0549
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-06
Last Update Date:2017-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child