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General NPI Number Information
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NPI Number | 1083228316
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Entity Type | Organization
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Legal Business Name | UNIQUE FAMILY TO FAMILY ADULT CARE HOME, LLC
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Dates
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Enumeration Date | 09/03/2020
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Last Update Date | 12/10/2021
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Provider Practice Location Address
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Address Line | 6981 W VILLA HERMOSA
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City | GLENDALE
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State | AZ
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Zip | 85310-5855
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Country | US
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Telephone | 623-252-5690
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Fax |
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Provider Business Mailing Address
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Address Line | 6981 W VILLA HERMOSA
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City | GLENDALE
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State | AZ
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Zip | 85310-5855
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Country | US
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Telephone | 623-252-5690
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KIRSTEN CARR
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Credential | MD
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Telephone | 623-252-5690
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State |
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