Healthcare Provider Details

I. General information

NPI: 1780005132
Provider Name (Legal Business Name): CITIZENS CARE TRANS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/02/2014
Last Update Date: 09/11/2025
Certification Date: 09/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3341 W DRAKE ST
CHANDLER AZ
85226-2317
US

IV. Provider business mailing address

3341 W DRAKE ST
CHANDLER AZ
85226-2317
US

V. Phone/Fax

Practice location:
  • Phone: 336-456-1560
  • Fax: 602-854-7555
Mailing address:
  • Phone: 336-456-1560
  • Fax: 602-854-7555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License NumberL18808290
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code163WR0400X
TaxonomyRehabilitation Registered Nurse
License Number
License Number StateNULL

VIII. Authorized Official

Name: MR. SALEH ISHAG SALEH BAROUKH
Title or Position: CEO/OWNER
Credential:
Phone: 336-456-1560