Provider Demographics
NPI: | 1952084865 |
---|---|
Name: | EMMANUEL CARE HOME INC. |
Entity Type: | Organization |
Organization Name: | EMMANUEL CARE HOME INC. |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | PRESIDENT |
Authorized Official - Prefix: | |
Authorized Official - First Name: | ANGELO |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | TIRAMBULO |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 520-748-8131 |
Mailing Address - Street 1: | 6414 E CALLE CAPPELA |
Mailing Address - Street 2: | |
Mailing Address - City: | TUCSON |
Mailing Address - State: | AZ |
Mailing Address - Zip Code: | 85710-5304 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 520-748-8131 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 6942 E CALLE JUPITER |
Practice Address - Street 2: | |
Practice Address - City: | TUCSON |
Practice Address - State: | AZ |
Practice Address - Zip Code: | 85710-5438 |
Practice Address - Country: | US |
Practice Address - Phone: | 520-790-1920 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | Yes |
Parent Organization LBN: | EMMANUEL CARE HOME INC. |
Parent Organization TIN: | <UNAVAIL> |
Enumeration Date: | 2023-08-08 |
Last Update Date: | 2023-08-08 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 310400000X | Nursing & Custodial Care Facilities | Assisted Living Facility |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
AZ | 478124 | Medicaid |