Healthcare Provider Details

I. General information

NPI: 1508539453
Provider Name (Legal Business Name): LOVE AND CARE III ASSISTED LIVING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2021
Last Update Date: 07/27/2021
Certification Date: 07/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17030 W SAND HILLS RD
SURPRISE AZ
85387-2009
US

IV. Provider business mailing address

17030 W SAND HILLS RD
SURPRISE AZ
85387-2009
US

V. Phone/Fax

Practice location:
  • Phone: 623-341-6957
  • Fax:
Mailing address:
  • Phone:
  • 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: NICOLETA HAGINEAGU
Title or Position: ADMINISTRATOR
Credential:
Phone: 623-341-6957