Healthcare Provider Details

I. General information

NPI: 1285547372
Provider Name (Legal Business Name): ANGEL CARE HOME ASSISTED LIVING AND MEMORY CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1510 E BROADWAY AVE
APACHE JUNCTION AZ
85119-5301
US

IV. Provider business mailing address

1510 E BROADWAY AVE
APACHE JUNCTION AZ
85119-5301
US

V. Phone/Fax

Practice location:
  • Phone: 602-475-0135
  • Fax:
Mailing address:
  • Phone: 602-475-0135
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number StateNULL

VIII. Authorized Official

Name: CIARA WARNER
Title or Position: OWNER/MANAGER
Credential: LPN
Phone: 602-475-0135