Healthcare Provider Details

I. General information

NPI: 1558669630
Provider Name (Legal Business Name): AJOOBA' CARE PARTNERS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2011
Last Update Date: 03/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

GORMAN'S TRAILER COURT S1 HIGHWAY 191
CHINLE AZ
86503
US

IV. Provider business mailing address

PO BOX 3994
CHINLE AZ
86503-3994
US

V. Phone/Fax

Practice location:
  • Phone: 928-714-8495
  • Fax:
Mailing address:
  • Phone: 928-714-8495
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number509075
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number509075
License Number StateAZ

VIII. Authorized Official

Name: MISS SHAWNA A. CLAW
Title or Position: OWNER
Credential: B.A.
Phone: 928-714-8495