Healthcare Provider Details

I. General information

NPI: 1659247435
Provider Name (Legal Business Name): DIFFERENTLY ABLED CARE GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2025
Last Update Date: 10/16/2025
Certification Date: 10/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

889 S 134TH PL
GILBERT AZ
85233-7746
US

IV. Provider business mailing address

889 S 134TH PL
GILBERT AZ
85233-7746
US

V. Phone/Fax

Practice location:
  • Phone: 808-462-8458
  • Fax:
Mailing address:
  • Phone: 808-462-8458
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number State

VIII. Authorized Official

Name: NIKOL LYN CASTRO
Title or Position: OWNER
Credential:
Phone: 808-462-8458