Provider Demographics
NPI:1881266328
Name:DOLORES HOME LLC
Entity type:Organization
Organization Name:DOLORES HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARCUS
Authorized Official - Middle Name:
Authorized Official - Last Name:HINOJOA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-401-5753
Mailing Address - Street 1:1645 W VALENCIA RD STE 109-434
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85746-6040
Mailing Address - Country:US
Mailing Address - Phone:520-401-5753
Mailing Address - Fax:
Practice Address - Street 1:9221 E DOLORES ST
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85730-2132
Practice Address - Country:US
Practice Address - Phone:520-401-5753
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-14
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home