Healthcare Provider Details

I. General information

NPI: 1902951908
Provider Name (Legal Business Name): MELODY CARE HOME LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1796 W RAY LN
APACHE JUNCTION AZ
85220-6818
US

IV. Provider business mailing address

1796 W RAY LN
APACHE JUNCTION AZ
85220-6818
US

V. Phone/Fax

Practice location:
  • Phone: 480-987-8549
  • Fax: 480-474-9321
Mailing address:
  • Phone: 480-987-8549
  • Fax: 480-474-9321

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License NumberALH-6022
License Number StateAZ

VIII. Authorized Official

Name: MRS. MYRNA TISMAL BAUTISTA
Title or Position: MANAGER
Credential:
Phone: 480-987-8549