Healthcare Provider Details

I. General information

NPI: 1669413050
Provider Name (Legal Business Name): FOUNDERS HEALTHCARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 08/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1512 JILL WAY STE 5 & 6
FORT MOHAVE AZ
86426
US

IV. Provider business mailing address

PO BOX 40700
MESA AZ
85274-0700
US

V. Phone/Fax

Practice location:
  • Phone: 928-704-4654
  • Fax: 928-704-4651
Mailing address:
  • Phone: 480-882-0535
  • Fax: 480-993-2033

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number361
License Number StateAZ

VIII. Authorized Official

Name: WILLIAM KEYS
Title or Position: CEO
Credential:
Phone: 480-446-9010