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General NPI Number Information
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NPI Number | 1740560069
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Entity Type | Organization
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Legal Business Name | HORIZON CARE HOME, LLC
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Dates
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Enumeration Date | 08/17/2011
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Last Update Date | 08/17/2011
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Provider Practice Location Address
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Address Line | 10802 N 57TH DR
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City | GLENDALE
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State | AZ
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Zip | 85304-3864
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Country | US
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Telephone | 602-547-6699
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Fax | 602-547-5006
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Provider Business Mailing Address
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Address Line | 10802 N 57TH DR
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City | GLENDALE
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State | AZ
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Zip | 85304-3864
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Country | US
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Telephone | 602-547-6699
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Fax | 602-547-5006
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. MARCO RHIVE AQUINO
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Credential |
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Telephone | 602-373-3223
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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 | AL8501H
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License Number State | AZ
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