Provider Demographics
NPI:1972820850
Name:PROFESSIONAL P.E.A.R.L.S., HOME CARE, LLC
Entity Type:Organization
Organization Name:PROFESSIONAL P.E.A.R.L.S., HOME CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:ROSALYN
Authorized Official - Middle Name:
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:312-617-7857
Mailing Address - Street 1:2600 E SPRINGFIELD PL
Mailing Address - Street 2:UNIT # 100
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85286-1409
Mailing Address - Country:US
Mailing Address - Phone:480-659-6161
Mailing Address - Fax:480-659-6161
Practice Address - Street 1:6151 W MONTE VISTA RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85035-3530
Practice Address - Country:US
Practice Address - Phone:480-659-6161
Practice Address - Fax:480-659-6161
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-30
Last Update Date:2010-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBH3469320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness