Provider Demographics
NPI:1205572922
Name:LOYAL CARE ASSISTED LIVING LLC
Entity type:Organization
Organization Name:LOYAL CARE ASSISTED LIVING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:NATACHA
Authorized Official - Middle Name:
Authorized Official - Last Name:CLERFOND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:484-522-6922
Mailing Address - Street 1:1338 W LOBO AVE
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85202-6651
Mailing Address - Country:US
Mailing Address - Phone:480-634-7252
Mailing Address - Fax:480-634-7252
Practice Address - Street 1:1338 W LOBO AVE
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85202-6651
Practice Address - Country:US
Practice Address - Phone:480-634-7252
Practice Address - Fax:480-634-7252
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-05
Last Update Date:2022-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0630XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Behavioral Disturbances