Organization
EL MIRAGE GROUP HOME
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DANIELA O MICULA (MANAGER)
(602) 367-6491
Entity
Organization
Contact information
Practice address
13045 W PORT ROYALE LN, EL MIRAGE, AZ 85335-3428
(602) 367-6491
(623) 582-8178
Mailing address
13045 W PORT ROYALE LN, EL MIRAGE, AZ 85335-3428
(602) 367-6491
(623) 582-8178
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
ALH-5221
AZ
Other
Enumeration date
06/08/2007
Last updated
08/22/2020
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