MEDICARE: A HOME FOR ME SERVICES 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	251S00000X	Community/Behavioral Health Agency
2	320800000X	Mental Illness Community Based Residential Treatment Facility

General Provider Information

NPI Number	:	1861068025
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	A HOME FOR ME SERVICES LLC

Provider Business Mailing Address
First Line	:	1810 W SOUTHERN AVE STE 103
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85041-4652
Country	:	US
Telephone Number	:	480-631-4783
Fax Number	:

Provider Business Practice Location Address
First Line	:	1810 W SOUTHERN AVE STE 103
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85041-4652
Country	:	US
Telephone Number	:	480-631-4783
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	KAREN BERRY
Credential	:
Telephone Number	:	480-631-4783

Provider Enumeration Date	:	05/28/2021
Last Update Date	:	05/28/2021

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Directions to “A HOME FOR ME SERVICES LLC ” Practice Location

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