1518466903 NPI number — ARMS OF LOVE ASSISTED LIVING HOME LLC

Table of content: DR. MARY ELIZABETH SHERLOCK YOUNG MD (NPI 1457646499)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518466903 NPI number — ARMS OF LOVE ASSISTED LIVING HOME LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ARMS OF LOVE ASSISTED LIVING 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:
6
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:
1518466903
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/12/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6086 S PEARL DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHANDLER
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85249-7090
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-329-0820
Provider Business Mailing Address Fax Number:
480-410-6757

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6086 S PEARL DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHANDLER
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85249
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-329-0820
Provider Business Practice Location Address Fax Number:
480-410-6757
Provider Enumeration Date:
02/12/2018

Additional Information

Authorized Official

Authorized Official Last Name:
KWAMBOKA
Authorized Official First Name:
GLADYS
Authorized Official Middle Name:
N/A
Authorized Official Title or Position:
ADMISTRATOR
Authorized Official Telephone Number:
480-329-0820

Provider Taxonomy Codes

  • Taxonomy code: 310400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: D06903789 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".




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