Provider Demographics
NPI:1881375053
Name:SORRENTO HOMES LLC
Entity type:Organization
Organization Name:SORRENTO HOMES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:DISHON
Authorized Official - Middle Name:
Authorized Official - Last Name:KARIUKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-237-6123
Mailing Address - Street 1:17652 N AVELINO DR
Mailing Address - Street 2:
Mailing Address - City:MARICOPA
Mailing Address - State:AZ
Mailing Address - Zip Code:85138-4979
Mailing Address - Country:US
Mailing Address - Phone:520-316-6070
Mailing Address - Fax:
Practice Address - Street 1:17652 N AVELINO DR
Practice Address - Street 2:
Practice Address - City:MARICOPA
Practice Address - State:AZ
Practice Address - Zip Code:85138-4979
Practice Address - Country:US
Practice Address - Phone:520-316-6070
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-31
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility