Healthcare Provider Details

I. General information

NPI: 1023644788
Provider Name (Legal Business Name): YOUR FAMILY ALF LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2020
Last Update Date: 03/13/2020
Certification Date: 03/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4865 E INDIAN DR
FLAGSTAFF AZ
86004-2717
US

IV. Provider business mailing address

4865 E INDIAN DR
FLAGSTAFF AZ
86004-2717
US

V. Phone/Fax

Practice location:
  • Phone: 928-607-2422
  • Fax:
Mailing address:
  • Phone: 928-607-2422
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: ANDREW CAIRD
Title or Position: OWNER
Credential:
Phone: 928-607-9950