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NPI Code Detail

MEDICARE: CITRUS CANYON CARE

MEDICARE: CITRUS CANYON CARE
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1310400000XAssisted Living Facility

General Provider Information

NPI Number : 1023862836
Entity Type Code : Organization
Provider Name (Legal Business Name) : CITRUS CANYON CARE
Provider Business Mailing Address
First Line : 2056 E PIEDMONT PL
Second Line :
City : CASA GRANDE
State : AZ
Zip : 85122-6812
Country : US
Telephone Number : 520-635-5164
Fax Number : 520-635-5164
Provider Business Practice Location Address
First Line : 2056 E PIEDMONT PL
Second Line :
City : CASA GRANDE
State : AZ
Zip : 85122-6812
Country : US
Telephone Number : 520-635-5164
Fax Number : 520-635-5164
Authorized Official
Title or Position : CEO
Name : DORCAS AKOTH OKENDO
Credential :
Telephone Number : 520-635-5164
Provider Enumeration Date : 04/16/2024
Last Update Date : 04/16/2024

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Directions to “CITRUS CANYON CARE ” Practice Location

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