MEDICARE: AUSTIN'S ADULT CARE HOMES, 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	ALH - 5070	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	476095	OTHER	AZ	AHCCCS PROVIDER NUMBER

General Provider Information

NPI Number	:	1841283561
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AUSTIN'S ADULT CARE HOMES, INC.

Provider Business Mailing Address
First Line	:	12224 N 65TH ST
Second Line	:
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85254-4506
Country	:	US
Telephone Number	:	480-991-9269
Fax Number	:	480-991-9269

Provider Business Practice Location Address
First Line	:	10818 N 34TH ST
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85028-3307
Country	:	US
Telephone Number	:	602-482-8386
Fax Number	:	602-482-8386

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. RICHARD WILLIS AUSTIN
Credential	:	NHA, MBA
Telephone Number	:	602-488-0922

Provider Enumeration Date	:	08/28/2005
Last Update Date	:	08/22/2020

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