Provider Demographics
NPI:1447548466
Name:ANGEL'S HEART ASSISTED LIVING
Entity type:Organization
Organization Name:ANGEL'S HEART ASSISTED LIVING
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER /MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KATRINA
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:THAMES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-343-1604
Mailing Address - Street 1:7815 E OBISPO AVE
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85212-1524
Mailing Address - Country:US
Mailing Address - Phone:480-415-3732
Mailing Address - Fax:480-380-3083
Practice Address - Street 1:7815 E OBISPO AVE
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85212-1524
Practice Address - Country:US
Practice Address - Phone:480-415-3732
Practice Address - Fax:480-380-3083
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-11
Last Update Date:2011-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care