MEDICARE: UNMERITED FAVOR SPECIAL CARE 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	3104A0630X	Assisted Living Facility (Behavioral Disturbances)

General Provider Information

NPI Number	:	1790405330
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNMERITED FAVOR SPECIAL CARE LLC

Provider Business Mailing Address
First Line	:	1610 W CORRAL RD
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85041-3780
Country	:	US
Telephone Number	:	602-675-2254
Fax Number	:

Provider Business Practice Location Address
First Line	:	1610 W CORRAL RD
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85041-3780
Country	:	US
Telephone Number	:	602-675-2254
Fax Number	:

Authorized Official
Title or Position	:	OWNER/MEMBER
Name	:	DR. EDMUND EGHAN
Credential	:
Telephone Number	:	614-260-9737

Provider Enumeration Date	:	09/01/2022
Last Update Date	:	09/01/2022

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