MEDICARE: LIVING HOPE COMMUNITY CARE CENTERS 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	311Z00000X	Custodial Care Facility

General Provider Information

NPI Number	:	1891240107
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIVING HOPE COMMUNITY CARE CENTERS LLC

Provider Business Mailing Address
First Line	:	PO BOX 9598
Second Line	:
City	:	CHANDLER HEIGHTS
State	:	AZ
Zip	:	85127-9598
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3026 E SAN MANUEL RD
Second Line	:
City	:	SAN TAN VALLEY
State	:	AZ
Zip	:	85143-4536
Country	:	US
Telephone Number	:	480-712-6170
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MR. CHAD ROCHE
Credential	:
Telephone Number	:	480-712-6170

Provider Enumeration Date	:	08/17/2016
Last Update Date	:	10/05/2016

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