Healthcare Provider Details

I. General information

NPI: 1922992437
Provider Name (Legal Business Name): MISSION GRACE HOME CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2025
Last Update Date: 06/07/2025
Certification Date: 06/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 W CALLE DEL SOL
PHOENIX AZ
85085-7086
US

IV. Provider business mailing address

2020 W CALLE DEL SOL
PHOENIX AZ
85085-7086
US

V. Phone/Fax

Practice location:
  • Phone: 623-343-3460
  • Fax:
Mailing address:
  • Phone: 623-343-3460
  • 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 Code3104A0630X
TaxonomyAssisted Living Facility (Behavioral Disturbances)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code311500000X
TaxonomyAlzheimer Center (Dementia Center)
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number State

VIII. Authorized Official

Name: DENNIS EMANUEL BURZ
Title or Position: MANAGER
Credential:
Phone: 623-343-3460