Angel Care Group Home

Key facts

NPI

1255868089

Entity type

Organization (NPI type 2)

Primary specialty

In Home Supportive Care Agency 253Z00000X

License

AL10296H (AZ)

Legal business name

ANGEL CARE GROUP HOME

Practice address

4624 W Paradise Dr
Glendale, AZ 85304-3029

Phone

(602) 772-7051

Fax

(602) 938-5295

NPI assigned

May 11, 2017

Organization subpart

No

Authorized official

Name

Ahmed Dfaalla NPI 1629467683

Title

Owner

Phone

(602) 772-7051

Authorized official NPPES reports the authorized official by name only; the link goes to the one practitioner connected to this organization with that name.

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Ahmed Mohamed Dfaalla Non-emergency Medical Transport (VAN) · Glendale, AZ · NPI 1629467683
  NPD (past) Authorized official

National Provider Directory

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on May 11, 2017.

{
    "created_epoch": "1494460800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1494460800000",
    "number": "1255868089",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4624 W PARADISE DR",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "853043029",
            "telephone_number": "602-772-7051",
            "fax_number": "602-938-5295"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4624 W PARADISE DR",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "853043029",
            "telephone_number": "602-772-7051",
            "fax_number": "602-938-5295"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ANGEL CARE GROUP HOME",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-05-11",
        "last_updated": "2017-05-11",
        "status": "A",
        "authorized_official_last_name": "DFAALLA",
        "authorized_official_first_name": "AHMED",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "602-772-7051"
    },
    "taxonomies": [
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": "AZ",
            "license": "AL10296H",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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