El Mirage Group Home LLC

NPI #1174247332 in El Mirage, Arizona

Provider Information

NPI Number: 1174247332
Entity Type: Organization
Organization Name: El Mirage Group Home LLC
Primary Specialty: Assisted Living Facility
Enumeration Date: Sep 30, 2022
Last Updated: Sep 30, 2022

Practice Location

Address: 13045 W PORT ROYALE LN
City: El Mirage
State: Arizona
ZIP Code: 85335-3428
Phone: (623) 694-5101

Authorized Official

Name: CORNELIA EDOH
Title: MEMBER/MANAGER
Phone: (623) 694-5101

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Assisted Living Facility	310400000X	Primary

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