Provider Demographics
NPI:1528446648
Name:PRATS CARE HOME L.L.C.
Entity type:Organization
Organization Name:PRATS CARE HOME L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:JESUS
Authorized Official - Last Name:PRATS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-568-8400
Mailing Address - Street 1:3015 E GELDING DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-5032
Mailing Address - Country:US
Mailing Address - Phone:602-348-2115
Mailing Address - Fax:602-996-1577
Practice Address - Street 1:13401 N 30TH ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-6028
Practice Address - Country:US
Practice Address - Phone:602-996-6854
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-08
Last Update Date:2015-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAL1754H3104A0625X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ531744OtherAHCCCS