Provider Demographics
NPI:1821746181
Name:VALLEY RESPITE AND HOME CARE LLC
Entity type:Organization
Organization Name:VALLEY RESPITE AND HOME CARE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER / STATUTORY AGENT
Authorized Official - Prefix:
Authorized Official - First Name:VIRGINIA
Authorized Official - Middle Name:
Authorized Official - Last Name:SIARA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-759-7072
Mailing Address - Street 1:4884 E IOLITE ST
Mailing Address - Street 2:
Mailing Address - City:SAN TAN VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85143-6359
Mailing Address - Country:US
Mailing Address - Phone:520-759-7072
Mailing Address - Fax:
Practice Address - Street 1:9407 E ALFALFA DR
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:AZ
Practice Address - Zip Code:85132-7352
Practice Address - Country:US
Practice Address - Phone:520-759-7072
Practice Address - Fax:520-759-7475
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-16
Last Update Date:2024-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness
No3104A0630XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Behavioral Disturbances
No311500000XNursing & Custodial Care FacilitiesAlzheimer Center (Dementia Center)
No385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ122110Medicaid