Provider Demographics
NPI:1861233108
Name:EMMAUS HOMES LLC
Entity type:Organization
Organization Name:EMMAUS HOMES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C.O.O
Authorized Official - Prefix:
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:
Authorized Official - Last Name:NGABIRE
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:480-692-1503
Mailing Address - Street 1:11580 W CORPORATE DR
Mailing Address - Street 2:
Mailing Address - City:AVONDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85323-1364
Mailing Address - Country:US
Mailing Address - Phone:480-692-1503
Mailing Address - Fax:
Practice Address - Street 1:2655 ROTHCHILD PL
Practice Address - Street 2:
Practice Address - City:BROWNSBURG
Practice Address - State:IN
Practice Address - Zip Code:46112-9365
Practice Address - Country:US
Practice Address - Phone:480-692-1503
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-03
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities