MEDICARE: PEOPLES HEALTH CARE CONNECTION, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1134605041
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEOPLES HEALTH CARE CONNECTION, LLC

Provider Business Mailing Address
First Line	:	3310 N EL BURRITO AVE
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85705-3404
Country	:	US
Telephone Number	:	520-300-4976
Fax Number	:

Provider Business Practice Location Address
First Line	:	3310 N EL BURRITO AVE
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85705-3404
Country	:	US
Telephone Number	:	520-300-4976
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	JIMMY NEALY
Credential	:
Telephone Number	:	520-795-3308

Provider Enumeration Date	:	07/13/2018
Last Update Date	:	07/13/2018

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