Provider Demographics
NPI:1720550767
Name:ANASTASIA ASSISTED LIVING HOME LLC
Entity Type:Organization
Organization Name:ANASTASIA ASSISTED LIVING HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:CRISTINA
Authorized Official - Last Name:BURCA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-221-1997
Mailing Address - Street 1:14417 W MAUNA LOA LANE
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85379
Mailing Address - Country:US
Mailing Address - Phone:623-221-1997
Mailing Address - Fax:623-218-8564
Practice Address - Street 1:12805 N 145TH AVE
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85379
Practice Address - Country:US
Practice Address - Phone:623-218-6564
Practice Address - Fax:623-218-6564
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-31
Last Update Date:2018-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility