Provider Demographics
NPI:1184412660
Name:ACTIVE CARE HOME III LLC
Entity type:Organization
Organization Name:ACTIVE CARE HOME III LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CRINA
Authorized Official - Middle Name:
Authorized Official - Last Name:GAVRILA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-236-5646
Mailing Address - Street 1:17826 N 56TH ST
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-5842
Mailing Address - Country:US
Mailing Address - Phone:480-236-5646
Mailing Address - Fax:602-535-5640
Practice Address - Street 1:17826 N 56TH ST
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85254-5842
Practice Address - Country:US
Practice Address - Phone:480-236-5646
Practice Address - Fax:602-535-5640
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-25
Last Update Date:2025-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility