Provider Demographics
NPI:1588745038
Name:AZURE GROUP HOME
Entity type:Organization
Organization Name:AZURE GROUP HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/PRESIDENT/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:YELENA
Authorized Official - Middle Name:
Authorized Official - Last Name:YEKTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-433-5368
Mailing Address - Street 1:4180 S PECOS RD
Mailing Address - Street 2:SUITE 115
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89121-5074
Mailing Address - Country:US
Mailing Address - Phone:702-433-5368
Mailing Address - Fax:702-434-2485
Practice Address - Street 1:4180 S PECOS RD
Practice Address - Street 2:SUITE 115
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89121-5074
Practice Address - Country:US
Practice Address - Phone:702-433-5368
Practice Address - Fax:702-434-2485
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered251B00000XAgenciesCase Management
Not Answered251C00000XAgenciesDay Training, Developmentally Disabled Services