NPIMap

Organization Active NPI

Family Care Assisted Living LLC

  • Assisted Living Facility
  • Glendale, AZ
National Provider Identifier
1992032031
Registry record updated Nov 10, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Assisted Living FacilityTaxonomy code 310400000X
License
AL7379H Issued in AZ
Legal business name
FAMILY CARE ASSISTED LIVING LLC
Practice address
4327 W Wahalla LN
Glendale, AZ 85308-7344
Phone
(623) 533-5131
Fax
(623) 565-8040
NPI assigned
Nov 10, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 10, 2009

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

Authorized official

Name
Pavel Miculit
Title
Owner
Phone
(623) 533-5131

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Assisted Living Facility 310400000X AL7379H AZ Primary

Addresses

Primary practice location

4327 W Wahalla LN
Glendale, AZ 85308-7344

Mailing address

4327 W Wahalla LN
Glendale, AZ 85308-7344
Phone (623) 533-5131

Other identifiers 1

IdentifierTypeStateIssuer
418233OtherAZAHCCCS

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1257811200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1257811200000",
    "number": "1992032031",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4327 W WAHALLA LN",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "853087344",
            "telephone_number": "623-533-5131",
            "fax_number": "623-565-8040"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4327 W WAHALLA LN",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "853087344",
            "telephone_number": "623-533-5131",
            "fax_number": "623-565-8040"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY CARE ASSISTED LIVING LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-11-10",
        "last_updated": "2009-11-10",
        "status": "A",
        "authorized_official_last_name": "MICULIT",
        "authorized_official_first_name": "PAVEL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "623-533-5131"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "AZ",
            "license": "AL7379H",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AHCCCS",
            "identifier": "418233",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Glendale, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 10, 2009; 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.