Organization Name: | EL MIRAGE GROUP HOME |
NPI Number: | 1801099692 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | DANIELA O MICULA (MANAGER) |
Mailing Address: | 13045 W Port Royale Ln El Mirage |
State: | AZ US |
Postal Code: | 853353428 |
Phone Number: | 6023676491 |
Fax Number: | 6235828178 |
NPI Enumeration Date: | 06/08/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 310400000X |
License Number: | ALH-5221 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | AZ |
Taxonomy Type: | Nursing & Custodial Care Facilities |
Taxonomy Classification: | Assisted Living Facility |
Taxonomy Specialization: | |
Taxonomy Definition: | A facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being. |