Healthcare Provider Details

I. General information

NPI: 1942073226
Provider Name (Legal Business Name): EMBRACE GROWTH HOME LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2023
Last Update Date: 10/30/2023
Certification Date: 10/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4872 E ST JOHN RD
SCOTTSDALE AZ
85254-0018
US

IV. Provider business mailing address

4872 E ST JOHN RD
SCOTTSDALE AZ
85254-0018
US

V. Phone/Fax

Practice location:
  • Phone: 480-241-7217
  • Fax:
Mailing address:
  • Phone: 480-241-7217
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3104A0630X
TaxonomyAssisted Living Facility (Behavioral Disturbances)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL

VIII. Authorized Official

Name: SIAW CHING CHUANG
Title or Position: CEO
Credential:
Phone: 480-241-7217