Provider Demographics
NPI:1891154043
Name:SACRED HEART LLC
Entity Type:Organization
Organization Name:SACRED HEART LLC
Other - Org Name:ASHTON RANCH HOME CARE
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:SALUMBIDES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-788-2233
Mailing Address - Street 1:13844 N 150TH DR
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85379-6020
Mailing Address - Country:US
Mailing Address - Phone:520-788-2233
Mailing Address - Fax:623-444-8435
Practice Address - Street 1:13844 N 150TH DR
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85379-6020
Practice Address - Country:US
Practice Address - Phone:520-788-2233
Practice Address - Fax:623-444-8435
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-16
Last Update Date:2016-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAL9707H310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility