MEDICARE: IMMANUEL CARING MINISTRIES, INC.

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
1	310400000X	Assisted Living Facility	ALC4369	AZ
2	314000000X	Skilled Nursing Facility	NCI066	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1265439889
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IMMANUEL CARING MINISTRIES, INC.

Provider Business Mailing Address
First Line	:	11301 N 99TH AVE
Second Line	:
City	:	PEORIA
State	:	AZ
Zip	:	85345-5466
Country	:	US
Telephone Number	:	623-977-8373
Fax Number	:	623-974-4849

Provider Business Practice Location Address
First Line	:	11301 N 99TH AVE
Second Line	:
City	:	PEORIA
State	:	AZ
Zip	:	85345-5466
Country	:	US
Telephone Number	:	623-977-8373
Fax Number	:	623-974-4849

Authorized Official
Title or Position	:	DIRECTOR OF FINANCE
Name	:	BARBARA ANN BYRUM-NIELSEN
Credential	:
Telephone Number	:	623-977-8373

Provider Enumeration Date	:	06/29/2005
Last Update Date	:	04/16/2024

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