Provider Demographics
NPI:1427682897
Name:RESILIENT HOMECARE AND GROUP HOME LLC
Entity type:Organization
Organization Name:RESILIENT HOMECARE AND GROUP HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ALI
Authorized Official - Middle Name:
Authorized Official - Last Name:SHABAZZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-405-9011
Mailing Address - Street 1:1505 E SAHUARO DR APT 4
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85020-1456
Mailing Address - Country:US
Mailing Address - Phone:602-405-9011
Mailing Address - Fax:
Practice Address - Street 1:1505 E SAHUARO DR APT 4
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85020-1456
Practice Address - Country:US
Practice Address - Phone:602-405-9011
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-25
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health