Organization
EL MIRAGE GROUP HOME LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CORNELIA EDOH (MEMBER/MANAGER)
(623) 694-5101
Entity
Organization
Contact information
Practice address
13045 W PORT ROYALE LN, EL MIRAGE, AZ 85335-3428
(623) 694-5101
Mailing address
13045 W PORT ROYALE LN, EL MIRAGE, AZ 85335-3428
(623) 694-5101
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
—
—
Other
Enumeration date
09/30/2022
Last updated
09/30/2022
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