Provider Demographics
NPI:1982763751
Name:CHANDLER ADULT CARE HOME
Entity Type:Organization
Organization Name:CHANDLER ADULT CARE HOME
Other - Org Name:CHANDLER A.C.H.-JOHN WAY
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATOR, MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ADELINA
Authorized Official - Middle Name:PANGANIBAN
Authorized Official - Last Name:SOMERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-786-6008
Mailing Address - Street 1:1781 E FOLLEY CT
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85225-2274
Mailing Address - Country:US
Mailing Address - Phone:480-786-6008
Mailing Address - Fax:480-659-6158
Practice Address - Street 1:1781 E FOLLEY CT
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85225-2274
Practice Address - Country:US
Practice Address - Phone:480-786-6008
Practice Address - Fax:480-659-6158
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1511311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ967755OtherAHCCCS
AZ456592OtherAHCCCS