Healthcare Provider Details

I. General information

NPI: 1770645335
Provider Name (Legal Business Name): MIRIAM'S ADULT CARE HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6426 W DEL MAR LN
GLENDALE AZ
85306-3138
US

IV. Provider business mailing address

6426 W DEL MAR LN
GLENDALE AZ
85306-3138
US

V. Phone/Fax

Practice location:
  • Phone: 623-776-3399
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number5360
License Number StateAZ

VIII. Authorized Official

Name: MIRELA GULER
Title or Position: MANAGER
Credential:
Phone: 623-776-3399