Organization
FAMILY CARE ASSISTED LIVING LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PAVEL MICULIT (OWNER)
(623) 533-5131
Entity
Organization
Contact information
Practice address
4327 W WAHALLA LN, GLENDALE, AZ 85308-7344
(623) 533-5131
(623) 565-8040
Mailing address
4327 W WAHALLA LN, GLENDALE, AZ 85308-7344
(623) 533-5131
(623) 565-8040
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
AL7379H
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
418233
AHCCCS
AZ
Enumeration date
11/10/2009
Last updated
11/10/2009
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