Provider Demographics
NPI:1245432152
Name:FREEDAZ LLC DBA GOLDEN DAYS ADULT CARE HOME
Entity type:Organization
Organization Name:FREEDAZ LLC DBA GOLDEN DAYS ADULT CARE HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GOVERNING AUTHORITY
Authorized Official - Prefix:DR
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:Q
Authorized Official - Last Name:ZAPANTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:602-694-5942
Mailing Address - Street 1:12414 N 38TH ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-7305
Mailing Address - Country:US
Mailing Address - Phone:602-795-5599
Mailing Address - Fax:602-795-5789
Practice Address - Street 1:12414 N 38TH ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-7305
Practice Address - Country:US
Practice Address - Phone:602-795-5599
Practice Address - Fax:602-795-5789
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZALH-4898310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility