Healthcare Provider Details

I. General information

NPI: 1700799756
Provider Name (Legal Business Name): CITRINE ASSISTED LIVING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2026
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3906 N 112TH LN
AVONDALE AZ
85392-3649
US

IV. Provider business mailing address

3906 N 112TH LN
AVONDALE AZ
85392-3649
US

V. Phone/Fax

Practice location:
  • Phone: 313-775-0059
  • Fax:
Mailing address:
  • Phone: 313-775-0059
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: ANDREA HUNT
Title or Position: OWNER/MANAGER
Credential:
Phone: 313-775-0059