1598395048 NPI number — FOX CARING HOME LLC

Table of content: (NPI 1598395048)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598395048 NPI number — FOX CARING HOME LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FOX CARING HOME LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1598395048
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/23/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
21895 N CELTIC AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MARICOPA
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85139-5473
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
520-510-0433
Provider Business Mailing Address Fax Number:
520-423-3316

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
21895 N CELTIC AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MARICOPA
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85139-5473
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
520-510-0433
Provider Business Practice Location Address Fax Number:
520-423-3316
Provider Enumeration Date:
01/23/2020

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
FOX
Authorized Official First Name:
LAURA
Authorized Official Middle Name:
NADINE
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
951-259-0431

Provider Taxonomy Codes

  • Taxonomy code: 311Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 385H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 177F00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 253J00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 253Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 452028 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".