Healthcare Provider Details

I. General information

NPI: 1710336854
Provider Name (Legal Business Name): GINA'S ANGELS HOME HEALTHCARE, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2016
Last Update Date: 04/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3282 S BOWMAN RD
APACHE JUNCTION AZ
85119-3684
US

IV. Provider business mailing address

3282 S BOWMAN RD
APACHE JUNCTION AZ
85119-3684
US

V. Phone/Fax

Practice location:
  • Phone: 602-773-6936
  • Fax: 888-897-8710
Mailing address:
  • Phone: 602-773-6936
  • Fax: 888-897-8710

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateAZ

VIII. Authorized Official

Name: REGINA L BROWN
Title or Position: OWNER
Credential:
Phone: 602-773-6936