Provider Demographics
NPI:1194927947
Name:CASA DEL REY ASSISTED LIVING CARE HOME
Entity type:Organization
Organization Name:CASA DEL REY ASSISTED LIVING CARE HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NICULAE
Authorized Official - Middle Name:
Authorized Official - Last Name:SPIREA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-414-3848
Mailing Address - Street 1:22284 N 102ND LN
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85383-2657
Mailing Address - Country:US
Mailing Address - Phone:623-414-3848
Mailing Address - Fax:623-537-4010
Practice Address - Street 1:22284 N 102ND LN
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85383-2657
Practice Address - Country:US
Practice Address - Phone:623-414-3848
Practice Address - Fax:623-537-4010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-04
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZALH-6315305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ185893Medicare ID - Type UnspecifiedAHCCCS PROVIDER