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General NPI Number Information
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NPI Number | 1548637200
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Entity Type | Organization
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Legal Business Name | DALLA MAE HOME CARE
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Dates
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Enumeration Date | 08/28/2015
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Last Update Date | 08/28/2015
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Provider Practice Location Address
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Address Line | 13690 E 55TH DR
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City | YUMA
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State | AZ
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Zip | 85367-8215
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Country | US
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Telephone | 928-248-4182
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Fax | 928-366-1671
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Provider Business Mailing Address
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Address Line | 13690 E 55TH DR
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City | YUMA
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State | AZ
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Zip | 85367-8215
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Country | US
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Telephone | 928-248-4182
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Fax | 928-366-1671
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Authorized Official
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Title or Position | OWNER
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Name | EDDA ADALLA CONTAOE MARCELO
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Credential |
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Telephone | 928-248-4182
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | AL9708H
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License Number State | AZ
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