Healthcare Provider Details

I. General information

NPI: 1609152560
Provider Name (Legal Business Name): LOVE AND CARE ASSISTED LIVING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2011
Last Update Date: 06/07/2021
Certification Date: 06/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18530 W PORT AU PRINCE LN
SURPRISE AZ
85388-7576
US

IV. Provider business mailing address

18530 W PORT AU PRINCE LN
SURPRISE AZ
85388-7576
US

V. Phone/Fax

Practice location:
  • Phone: 602-339-3617
  • Fax:
Mailing address:
  • Phone: 623-341-6957
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License NumberAL2586H
License Number StateAZ

VIII. Authorized Official

Name: NICOLETA HAGINEAGU
Title or Position: MEMBER
Credential:
Phone: 623-341-6957