Healthcare Provider Details

I. General information

NPI: 1619626868
Provider Name (Legal Business Name): MY HOME LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2022
Last Update Date: 03/23/2022
Certification Date: 03/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2142 S GERONIMO RD
APACHE JUNCTION AZ
85119-8816
US

IV. Provider business mailing address

2142 S GERONIMO RD
APACHE JUNCTION AZ
85119-8816
US

V. Phone/Fax

Practice location:
  • Phone: 480-635-2566
  • Fax:
Mailing address:
  • Phone: 480-635-2566
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253J00000X
TaxonomyFoster Care Agency
License Number
License Number State

VIII. Authorized Official

Name: NADIA MURPHY
Title or Position: OWNER
Credential:
Phone: 480-635-2566