Healthcare Provider Details

I. General information

NPI: 1730875303
Provider Name (Legal Business Name): ASM HOME CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2023
Last Update Date: 02/05/2024
Certification Date: 02/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

854 E MORELOS ST
CHANDLER AZ
85225-6465
US

IV. Provider business mailing address

6326 S 24TH PL
PHOENIX AZ
85042-5967
US

V. Phone/Fax

Practice location:
  • Phone: 336-255-5507
  • Fax:
Mailing address:
  • Phone: 336-255-5507
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: ASIM KHOGALI
Title or Position: MANAGER
Credential:
Phone: 336-255-5507