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General NPI Number Information
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NPI Number | 1023570355
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Entity Type | Organization
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Legal Business Name | GIFTED HEARTS GROUP HOMES LLC
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Dates
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Enumeration Date | 04/04/2019
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Last Update Date | 04/04/2019
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Provider Practice Location Address
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Address Line | 45763 W DIRK ST
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City | MARICOPA
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State | AZ
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Zip | 85139-6611
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Country | US
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Telephone | 602-303-8582
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Fax |
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Provider Business Mailing Address
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Address Line | 45763 W DIRK ST
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City | MARICOPA
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State | AZ
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Zip | 85139-6611
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Country | US
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Telephone | 602-303-8582
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Fax |
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Authorized Official
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Title or Position | CO-OWNER
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Name | ANDREWS SAMUKA
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Credential | BUSINESS OWNER
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Telephone | 928-257-7819
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3104A0630X
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Taxonomy Name | Assisted Living Facility (Behavioral Disturbances)
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License Number |
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License Number State |
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