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General NPI Number Information
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NPI Number | 1770250557
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Entity Type | Organization
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Legal Business Name | THE FAMILY HOUSE RESPITE CENTER, LLC
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Dates
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Enumeration Date | 08/27/2021
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Last Update Date | 09/02/2021
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Provider Practice Location Address
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Address Line | 6014 W AUGUSTA AVE
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City | GLENDALE
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State | AZ
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Zip | 85301-1234
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Country | US
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Telephone | 623-939-6262
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Fax |
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Provider Business Mailing Address
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Address Line | 6014 W AUGUSTA AVE
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City | GLENDALE
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State | AZ
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Zip | 85301-1234
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Country | US
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Telephone | 623-939-6262
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. ORA GHOLSON
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Credential |
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Telephone | 623-939-6262
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 385H00000X
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Taxonomy Name | Respite Care
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License Number |
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License Number State |
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