THE HARBOR LIGHHOUSE II
Adult Care Home
Glendale, Arizona
Provider NPI: 1336477520
Organization Information:Organization Name: THE HARBOR LIGHHOUSE II
Practice Location:
4142 W GROVERS AVE GLENDALE, AZ 85308 US
Tel: 602-358-8604 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:
4142 W GROVERS AVE GLENDALE, AZ 85308 US
Tel: 602-358-8604 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-6343 |
Other Provider Identifiers:
Issuer | Number | State | Type |
---|---|---|---|
ASSISTED LIVING HOME LICENSE | AHL-6343 | AZ | 01 |
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin