Provider Demographics
NPI:1538563143
Name:ABOUT SENIORS ASSISTED LIVING HOME, LLC
Entity type:Organization
Organization Name:ABOUT SENIORS ASSISTED LIVING HOME, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER/MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:DENISA
Authorized Official - Middle Name:
Authorized Official - Last Name:KAPORALIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-339-3617
Mailing Address - Street 1:17343 W BAJADA DR
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85387-1002
Mailing Address - Country:US
Mailing Address - Phone:602-339-3617
Mailing Address - Fax:
Practice Address - Street 1:17343 W BAJADA DR
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85387-1002
Practice Address - Country:US
Practice Address - Phone:602-339-3617
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-11
Last Update Date:2014-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAL 9389310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAL9389OtherHEALTH DEPARTMENT