Provider Demographics
NPI:1548963184
Name:FERVOUR GROUP HOMES LLC
Entity type:Organization
Organization Name:FERVOUR GROUP HOMES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JUNE
Authorized Official - Middle Name:WAMBUI
Authorized Official - Last Name:MWANGI
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:562-277-6323
Mailing Address - Street 1:2059 E PIEDMONT PL
Mailing Address - Street 2:
Mailing Address - City:CASA GRANDE
Mailing Address - State:AZ
Mailing Address - Zip Code:85122-6813
Mailing Address - Country:US
Mailing Address - Phone:562-277-6323
Mailing Address - Fax:
Practice Address - Street 1:2059 E PIEDMONT PL
Practice Address - Street 2:
Practice Address - City:CASA GRANDE
Practice Address - State:AZ
Practice Address - Zip Code:85122-6813
Practice Address - Country:US
Practice Address - Phone:562-277-6323
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-23
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0630XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Behavioral Disturbances