=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366333742
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ELDORADO CARE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/14/2025
-----------------------------------------------------
Last Update Date | 07/14/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1685 E DUBOIS AVE
-----------------------------------------------------
City | GILBERT
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85298-0825
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 623-451-8758
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1685 E DUBOIS AVE
-----------------------------------------------------
City | GILBERT
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85298-0825
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 315-261-1861
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | BAMIDELE FALOLA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 315-261-1861
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------