Healthcare Provider Details

I. General information

NPI: 1437964442
Provider Name (Legal Business Name): CARNELIAN SOCIAL SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2025
Last Update Date: 02/08/2025
Certification Date: 02/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8622 N 59TH AVE APT 2081
GLENDALE AZ
85302-5499
US

IV. Provider business mailing address

8622 N 59TH AVE APT 2081
GLENDALE AZ
85302-5499
US

V. Phone/Fax

Practice location:
  • Phone: 719-744-2794
  • Fax:
Mailing address:
  • Phone: 719-744-2794
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code315P00000X
TaxonomyIntellectual Disabilities Intermediate Care Facility
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: MISS CHRISTIANAH O OLALEYE
Title or Position: EXECUTIVE
Credential:
Phone: 719-944-2794