Healthcare Provider Details

I. General information

NPI: 1609730266
Provider Name (Legal Business Name): SALEM ASSISTED HOME CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2025
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17655 W HALE BOPP DR
GOODYEAR AZ
85338-5469
US

IV. Provider business mailing address

17655 W HALE BOPP DR
GOODYEAR AZ
85338-5469
US

V. Phone/Fax

Practice location:
  • Phone: 602-299-1060
  • Fax:
Mailing address:
  • Phone: 602-299-1060
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: JEUMIEL KAZADI
Title or Position: CEO
Credential:
Phone: 623-313-4714