Provider Demographics
NPI:1164821278
Name:ARIZONA CHILDREN HOME,LLC
Entity type:Organization
Organization Name:ARIZONA CHILDREN HOME,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:B
Authorized Official - Last Name:UDOINWANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-757-4861
Mailing Address - Street 1:PO BOX 14392
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85063-4392
Mailing Address - Country:US
Mailing Address - Phone:623-388-3458
Mailing Address - Fax:623-388-6948
Practice Address - Street 1:9403 W SHERIDAN ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85037-4338
Practice Address - Country:US
Practice Address - Phone:623-388-3458
Practice Address - Fax:623-388-6948
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-14
Last Update Date:2014-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBH44543104A0630X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0630XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Behavioral Disturbances
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZBH4454OtherARIZONA DEPARTMENT OF HEALTH SERVICES