Healthcare Provider Details

I. General information

NPI: 1083228316
Provider Name (Legal Business Name): UNIQUE FAMILY TO FAMILY ADULT CARE HOME, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2020
Last Update Date: 12/10/2021
Certification Date: 12/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6981 W VILLA HERMOSA
GLENDALE AZ
85310-5855
US

IV. Provider business mailing address

6981 W VILLA HERMOSA
GLENDALE AZ
85310-5855
US

V. Phone/Fax

Practice location:
  • Phone: 623-252-5690
  • Fax:
Mailing address:
  • Phone: 623-252-5690
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: KIRSTEN CARR
Title or Position: OWNER
Credential: MD
Phone: 623-252-5690