AMANDA'S CARE HOME LLC
Adult Care Home
Mesa, Arizona
Provider NPI: 1811044944
Organization Information:Organization Name: AMANDA'S CARE HOME LLC
Practice Location:
8647 E PAMPA AVE MESA, AZ 85212 US
Tel: 480-373-8437 Fax: --
Business Mailing Address:
,
Tel: -- Fax: --
Taxonomy:
Other Provider Identifiers:
Code values:
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin
Practice Location:
8647 E PAMPA AVE MESA, AZ 85212 US
Tel: 480-373-8437 Fax: --
Business Mailing Address:
,
Tel: -- Fax: --
Taxonomy:
Primary | Code | Category/Description | State | License Number |
---|---|---|---|---|
Y | 311ZA0620X | Nursing & Custodial Care Facilities Custodial Care Facility Adult Care Home | AZ | ALH-A108 |
Other Provider Identifiers:
Issuer | Number | State | Type |
---|---|---|---|
AHCCCS PROVIDER ID NUMBER | 774267 | AZ | 01 |
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin