Provider Demographics
NPI:1861606923
Name:HOME & COMMUNITY BASED SERVICES INC
Entity type:Organization
Organization Name:HOME & COMMUNITY BASED SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:PENNY
Authorized Official - Last Name:PERONTO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-516-1305
Mailing Address - Street 1:711 E CAREFREE HWY
Mailing Address - Street 2:#102-741
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85085-0101
Mailing Address - Country:US
Mailing Address - Phone:623-516-1305
Mailing Address - Fax:
Practice Address - Street 1:34322 N 14TH ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85085-7791
Practice Address - Country:US
Practice Address - Phone:623-516-1305
Practice Address - Fax:623-516-1605
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered251C00000XAgenciesDay Training, Developmentally Disabled Services
Not Answered251E00000XAgenciesHome Health
Not Answered385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ157447OtherAHCCCS PROVIDER #