Provider Demographics
NPI:1952789034
Name:AZI HOUSE
Entity Type:Organization
Organization Name:AZI HOUSE
Other - Org Name:NORTHWEST ASSISTED LIVING HOMES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:C.E.O AZI HOUSE LLC
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:FUANGUNYI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-643-0815
Mailing Address - Street 1:5986 S JAKEMP TRL
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85747-6003
Mailing Address - Country:US
Mailing Address - Phone:240-643-0815
Mailing Address - Fax:520-844-6342
Practice Address - Street 1:2001 W CASSIM LN
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704-1217
Practice Address - Country:US
Practice Address - Phone:240-643-0815
Practice Address - Fax:520-396-4658
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-11
Last Update Date:2020-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAL11549HOtherARIZONA STATE LICENSE