Provider Demographics
NPI:1245309723
Name:CHRISOL CARE HOME
Entity type:Organization
Organization Name:CHRISOL CARE HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:ALAGABAN
Authorized Official - Last Name:MANAS
Authorized Official - Suffix:
Authorized Official - Credentials:ASSISTEDLIVING
Authorized Official - Phone:623-266-0552
Mailing Address - Street 1:17316 W TARA LN
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85388-1216
Mailing Address - Country:US
Mailing Address - Phone:623-266-0552
Mailing Address - Fax:623-266-0552
Practice Address - Street 1:17316 W TARA LN
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85388-1216
Practice Address - Country:US
Practice Address - Phone:623-266-0552
Practice Address - Fax:623-266-0552
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZALH5940310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility