Provider Demographics
NPI:1013175512
Name:ELDERCARE FOR LIFE INC
Entity Type:Organization
Organization Name:ELDERCARE FOR LIFE INC
Other - Org Name:WINDMILL RANCH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ALF MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:DOUD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-803-1234
Mailing Address - Street 1:PO BOX 429
Mailing Address - Street 2:
Mailing Address - City:HEREFORD
Mailing Address - State:AZ
Mailing Address - Zip Code:85615-0429
Mailing Address - Country:US
Mailing Address - Phone:520-803-1234
Mailing Address - Fax:520-803-6552
Practice Address - Street 1:5605 E LABRADOR LN
Practice Address - Street 2:
Practice Address - City:HEREFORD
Practice Address - State:AZ
Practice Address - Zip Code:85615-8110
Practice Address - Country:US
Practice Address - Phone:520-803-7181
Practice Address - Fax:520-803-9724
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-30
Last Update Date:2011-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZALH6517310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility