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General NPI Number Information
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NPI Number | 1548785884
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Entity Type | Organization
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Legal Business Name | AZ COMFORT HOME LLC
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Dates
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Enumeration Date | 08/08/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 23832 W TONTO STREET
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City | BUCKEYE
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State | AZ
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Zip | 85326
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Country | US
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Telephone | 623-666-3895
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Fax | 623-321-1206
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Provider Business Mailing Address
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Address Line | 23832 W TONTO ST
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City | BUCKEYE
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State | AZ
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Zip | 85326-8139
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Country | US
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Telephone | 623-666-3895
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Fax | 623-321-1206
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Authorized Official
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Title or Position | PROGRAM DIRECTOR
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Name | MR. JOHN OMIJIE
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Credential |
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Telephone | 623-326-3327
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number | BH5219
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License Number State | AZ
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