Healthcare Provider Details

I. General information

NPI: 1396677241
Provider Name (Legal Business Name): HOLYHEIGHT CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2026
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9571 W ILLINI ST
TOLLESON AZ
85353-4561
US

IV. Provider business mailing address

9571 W ILLINI ST
TOLLESON AZ
85353-4561
US

V. Phone/Fax

Practice location:
  • Phone: 585-748-7719
  • Fax:
Mailing address:
  • Phone: 585-748-7719
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: YVONNE MAKUZA
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: LPN
Phone: 585-748-7719