Organization · NPI-2

412 Home LLC

Assisted Living Facility · Mesa, AZ

NPI number1245016344
StatusActive
Last updated in NPPESSep 5, 2023

Details

NPI
1245016344
Entity type
Organization (NPI-2)
Legal business name
412 Home LLC
Organization subpart
No
Enumeration date
Sep 5, 2023
Certification date
Sep 5, 2023
Last updated
Sep 5, 2023

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
310400000X Assisted Living Facility––Yes

Other names

  • Jones Family Care Home (Doing Business As)

Practice location

412 S 30th St
Mesa, AZ 85204-3111

Phone 480-584-5666 · Fax 480-588-5460

Mailing address

412 S 30th St
Mesa, AZ 85204-3111

Phone 480-584-5666 · Fax 480-588-5460

Authorized official

Chaim Zimmerman
Manager
4809859695

Is something wrong?

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