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General NPI Number Information
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NPI Number | 1821618679
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Entity Type | Organization
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Legal Business Name | KLARA'S II ADULT CARE HOME
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Dates
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Enumeration Date | 04/22/2020
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Last Update Date | 04/22/2020
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Provider Practice Location Address
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Address Line | 2974 E PONY CT
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City | GILBERT
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State | AZ
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Zip | 85295-3775
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Country | US
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Telephone | 480-988-2134
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Fax |
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Provider Business Mailing Address
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Address Line | 2974 E PONY CT
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City | GILBERT
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State | AZ
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Zip | 85295-3775
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Country | US
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Telephone | 480-988-2134
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | MRS. AMELIA ABELLA TAGALOGUIN
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Credential | RN
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Telephone | 480-338-0834
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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 |
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License Number State |
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