MEDICARE: ACOME HOME LLC

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	320800000X	Mental Illness Community Based Residential Treatment Facility

General Provider Information

NPI Number	:	1699394858
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ACOME HOME LLC

Provider Business Mailing Address
First Line	:	4509 E ACOMA DR
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85032-4855
Country	:	US
Telephone Number	:	480-266-2461
Fax Number	:

Provider Business Practice Location Address
First Line	:	4509 E ACOMA DR
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85032-4855
Country	:	US
Telephone Number	:	480-266-2461
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	KEVIN MAFTEAN
Credential	:
Telephone Number	:	480-266-2461

Provider Enumeration Date	:	04/08/2020
Last Update Date	:	04/08/2020

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Directions to “ACOME HOME LLC ” Practice Location

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