Provider Demographics
NPI:1225278732
Name:AFFECTION CARE ASSISTED LIVING LLC
Entity type:Organization
Organization Name:AFFECTION CARE ASSISTED LIVING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:MIROSLAV
Authorized Official - Middle Name:
Authorized Official - Last Name:CIGIC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-996-1487
Mailing Address - Street 1:3935 E MERCER LN
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85028-3437
Mailing Address - Country:US
Mailing Address - Phone:602-996-1487
Mailing Address - Fax:602-923-0215
Practice Address - Street 1:3935 E MERCER LN
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85028-3437
Practice Address - Country:US
Practice Address - Phone:602-996-1487
Practice Address - Fax:602-923-0215
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-23
Last Update Date:2009-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZALH-6762310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility