Healthcare Provider Details

I. General information

NPI: 1881319374
Provider Name (Legal Business Name): KAIZEN GROUP HOMES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2022
Last Update Date: 10/06/2022
Certification Date: 10/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1877 E ANGELICA ST
CASA GRANDE AZ
85122-6534
US

IV. Provider business mailing address

42107 ALEXANDRA DR
MURRIETA CA
92562-3485
US

V. Phone/Fax

Practice location:
  • Phone: 949-295-5345
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: NANCY MWANIA
Title or Position: ADMINISTRATOR
Credential:
Phone: 949-295-5345