Provider Demographics
NPI:1811526148
Name:PHOENIX COMFORT HOMES LLC
Entity type:Organization
Organization Name:PHOENIX COMFORT HOMES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:HUSSEIN
Authorized Official - Middle Name:AHMED
Authorized Official - Last Name:HASSAN
Authorized Official - Suffix:
Authorized Official - Credentials:MSC
Authorized Official - Phone:612-913-6133
Mailing Address - Street 1:17643 N 17TH ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85022-2113
Mailing Address - Country:US
Mailing Address - Phone:602-358-7936
Mailing Address - Fax:602-358-7936
Practice Address - Street 1:17643 N 17TH ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85022-2113
Practice Address - Country:US
Practice Address - Phone:602-358-7936
Practice Address - Fax:602-358-7936
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-07
Last Update Date:2020-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness