Healthcare Provider Details

I. General information

NPI: 1154242485
Provider Name (Legal Business Name): SOPHIES ASSISTED LIVING HOME PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2026
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2324 W GRENADINE RD
PHOENIX AZ
85041-3345
US

IV. Provider business mailing address

2324 W GRENADINE RD
PHOENIX AZ
85041-3345
US

V. Phone/Fax

Practice location:
  • Phone: 602-692-2020
  • Fax:
Mailing address:
  • Phone: 602-692-2020
  • 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: FREWOINI HABTEMARIAM
Title or Position: OWNER
Credential:
Phone: 602-692-2020