MEDICARE: HOMEBASE ARCADIA LLC

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	320800000X	Mental Illness Community Based Residential Treatment Facility
2	324500000X	Substance Abuse Rehabilitation Facility

General Provider Information

NPI Number	:	1932846714
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOMEBASE ARCADIA LLC

Provider Business Mailing Address
First Line	:	1839 N 39TH ST
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85008-3915
Country	:	US
Telephone Number	:	480-440-4916
Fax Number	:

Provider Business Practice Location Address
First Line	:	1839 N 39TH ST
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85008-3915
Country	:	US
Telephone Number	:	480-440-4916
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	OLAJUMOKE IJABADENUYI
Credential	:
Telephone Number	:	323-671-6789

Provider Enumeration Date	:	05/13/2022
Last Update Date	:	09/26/2023

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Directions to “HOMEBASE ARCADIA LLC ” Practice Location

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