MEDICARE: PRATS CARE HOME L.L.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3104A0625X	Assisted Living Facility (Mental Illness)	AL1754H	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	531744	OTHER	AZ	AHCCCS

General Provider Information

NPI Number	:	1528446648
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRATS CARE HOME L.L.C.

Provider Business Mailing Address
First Line	:	3015 E GELDING DR
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85032-5032
Country	:	US
Telephone Number	:	602-348-2115
Fax Number	:	602-996-1577

Provider Business Practice Location Address
First Line	:	13401 N 30TH ST
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85032-6028
Country	:	US
Telephone Number	:	602-996-6854
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MR. LUIS JESUS PRATS
Credential	:
Telephone Number	:	602-568-8400

Provider Enumeration Date	:	05/08/2015
Last Update Date	:	05/08/2015

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