Healthcare Provider Details

I. General information

NPI: 1528819653
Provider Name (Legal Business Name): ARK OF NOAH CARE HOME, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2024
Last Update Date: 03/28/2024
Certification Date: 03/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4685 E ALAMO ST
SAN TAN VALLEY AZ
85140-4543
US

IV. Provider business mailing address

4685 E ALAMO ST
SAN TAN VALLEY AZ
85140-4543
US

V. Phone/Fax

Practice location:
  • Phone: 480-202-1674
  • Fax:
Mailing address:
  • Phone: 480-202-1674
  • 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: FRANK ANTHONY MWINYELLE
Title or Position: OWNER/MANAGER
Credential:
Phone: 480-202-1674