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General NPI Number Information
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NPI Number | 1770829848
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Entity Type | Organization
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Legal Business Name | HORIZON CARE HOME
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Dates
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Enumeration Date | 12/18/2012
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Last Update Date | 12/18/2012
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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 | 85304-3867
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Country | US
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Telephone | 623-547-6699
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Fax | 623-792-5698
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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 | 623-547-6699
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Fax | 623-792-5698
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MA GRACE CORAZON JUACHON FERNANDEZ
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Credential |
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Telephone | 602-710-8782
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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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