=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952168619
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SURPRISE COMFORT HOME CARE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/29/2024
-----------------------------------------------------
Last Update Date | 02/29/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 16552 N HOLLYHOCK ST
-----------------------------------------------------
City | SURPRISE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85378-3667
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-381-7414
-----------------------------------------------------
Fax | 623-399-1040
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 17985 W ASHLEY DR
-----------------------------------------------------
City | GOODYEAR
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85338-6098
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-381-7414
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | SEAN LANEY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 480-381-7414
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 310400000X
-----------------------------------------------------
Taxonomy Name | Assisted Living Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------