MEDICARE: PROFESSIONAL P.E.A.R.L.S., HOME 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	320800000X	Mental Illness Community Based Residential Treatment Facility	BH3469	AZ

General Provider Information

NPI Number	:	1972820850
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROFESSIONAL P.E.A.R.L.S., HOME CARE, LLC

Provider Business Mailing Address
First Line	:	2600 E SPRINGFIELD PL
Second Line	:	UNIT # 100
City	:	CHANDLER
State	:	AZ
Zip	:	85286-1409
Country	:	US
Telephone Number	:	480-659-6161
Fax Number	:	480-659-6161

Provider Business Practice Location Address
First Line	:	6151 W MONTE VISTA RD
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85035-3530
Country	:	US
Telephone Number	:	480-659-6161
Fax Number	:	480-659-6161

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MISS ROSALYN YOUNG
Credential	:	MBA
Telephone Number	:	312-617-7857

Provider Enumeration Date	:	04/30/2010
Last Update Date	:	04/30/2010

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