Healthcare Provider Details

I. General information

NPI: 1255681441
Provider Name (Legal Business Name): A FAMILY AFFAIR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2012
Last Update Date: 09/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15801 N 19TH PL
PHOENIX AZ
85022-3313
US

IV. Provider business mailing address

15801 N 19TH PL
PHOENIX AZ
85022-3313
US

V. Phone/Fax

Practice location:
  • Phone: 213-804-7694
  • Fax:
Mailing address:
  • Phone: 213-804-7694
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License NumberAL5715H
License Number StateAZ

VIII. Authorized Official

Name: MR. EDWARD M IONESCU
Title or Position: OWNER/CAREGIVER MANAGER
Credential:
Phone: 213-804-7694