Provider Demographics
NPI:1548637200
Name:DALLA MAE HOME CARE
Entity type:Organization
Organization Name:DALLA MAE HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EDDA ADALLA
Authorized Official - Middle Name:CONTAOE
Authorized Official - Last Name:MARCELO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-248-4182
Mailing Address - Street 1:13690 E 55TH DR
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85367-8215
Mailing Address - Country:US
Mailing Address - Phone:928-248-4182
Mailing Address - Fax:928-366-1671
Practice Address - Street 1:13690 E 55TH DR
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85367-8215
Practice Address - Country:US
Practice Address - Phone:928-248-4182
Practice Address - Fax:928-366-1671
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-28
Last Update Date:2015-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAL9708H310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility