Healthcare Provider Details

I. General information

NPI: 1336852870
Provider Name (Legal Business Name): TECH CAPITAL SOURCE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2022
Last Update Date: 12/29/2022
Certification Date: 12/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5977 E 18TH AVE
APACHE JUNCTION AZ
85119-7703
US

IV. Provider business mailing address

5977 E 18TH AVE
APACHE JUNCTION AZ
85119-7703
US

V. Phone/Fax

Practice location:
  • Phone: 480-800-7027
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: JEFF GLOVER
Title or Position: OWNER
Credential:
Phone: 480-331-1088