Provider Demographics
NPI:1265439889
Name:IMMANUEL CARING MINISTRIES, INC.
Entity type:Organization
Organization Name:IMMANUEL CARING MINISTRIES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:BYRUM-NIELSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-977-8373
Mailing Address - Street 1:11301 N 99TH AVE
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85345-5466
Mailing Address - Country:US
Mailing Address - Phone:623-977-8373
Mailing Address - Fax:623-974-4849
Practice Address - Street 1:11301 N 99TH AVE
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85345-5466
Practice Address - Country:US
Practice Address - Phone:623-977-8373
Practice Address - Fax:623-974-4849
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-29
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZALC4369310400000X
AZNCI066314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ447591Medicaid
AZ447591Medicaid