El Mirage Group Home LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

EL MIRAGE GROUP HOME LLC

Practice address

13045 W Port Royale LN
El Mirage, AZ 85335-3428

Phone

(623) 694-5101

NPI assigned

Sep 30, 2022

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Cornelia Edoh

Title

Member/Manager

Phone

(623) 694-5101

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1664496000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1664496000000",
    "number": "1174247332",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13045 W PORT ROYALE LN",
            "city": "EL MIRAGE",
            "state": "AZ",
            "postal_code": "853353428",
            "telephone_number": "623-694-5101"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13045 W PORT ROYALE LN",
            "city": "EL MIRAGE",
            "state": "AZ",
            "postal_code": "853353428",
            "telephone_number": "623-694-5101"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EL MIRAGE GROUP HOME LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-09-30",
        "last_updated": "2022-09-30",
        "certification_date": "2022-09-30",
        "status": "A",
        "authorized_official_last_name": "EDOH",
        "authorized_official_first_name": "CORNELIA",
        "authorized_official_title_or_position": "MEMBER/MANAGER",
        "authorized_official_telephone_number": "623-694-5101"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dysart Unified School District
• El Mirage Dental Partners LLC
• El Mirage Dentistry
• El Mirage Emergency Room and Medical Center
• El Mirage Group Home
• Stacie Lynn Elliott, RPH
• Empaljit Singh Gill, PLLC
• Amorita Enyioma
• Kathleen L Eppich, LPN
• Essence of Wellness LLC

• Assisted Living Facility in El Mirage, AZ
• Providers in El Mirage, AZ by specialty
• Assisted Living Facility in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.