Provider Demographics
NPI:1174202758
Name:SIMPLE LIVING ASSISTED HOME CARE, LLC
Entity type:Organization
Organization Name:SIMPLE LIVING ASSISTED HOME CARE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:IRENE
Authorized Official - Middle Name:
Authorized Official - Last Name:FON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-440-9086
Mailing Address - Street 1:24445 N 168TH LN
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85387-2099
Mailing Address - Country:US
Mailing Address - Phone:623-272-6450
Mailing Address - Fax:
Practice Address - Street 1:24445 N 168TH LN
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85387-2099
Practice Address - Country:US
Practice Address - Phone:623-272-6450
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-12
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility