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General NPI Number Information
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NPI Number | 1679947238
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Entity Type | Organization
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Legal Business Name | GARCIA'S ASSISTED LIVING HOME LLC
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Dates
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Enumeration Date | 11/19/2015
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Last Update Date | 11/19/2015
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Provider Practice Location Address
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Address Line | 2742 E PUEBLO AVENUE
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City | PHOENIX
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State | AZ
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Zip | 85040
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Country | US
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Telephone | 480-612-2569
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Fax | 602-687-9118
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Provider Business Mailing Address
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Address Line | 2742 E. PUEBLO AVE.
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City | PHOENIX
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State | AZ
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Zip | 85040
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Country | US
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Telephone | 480-612-2569
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Fax | 602-687-9118
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Authorized Official
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Title or Position | OWNER
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Name | MRS. ANALYN M GARCIA
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Credential |
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Telephone | 480-612-2569
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number | AL9638H
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License Number State | AZ
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