Healthcare Provider Details

I. General information

NPI: 1326400847
Provider Name (Legal Business Name): MINDFUL HOME HEALTH PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2016
Last Update Date: 03/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2487 S GILBERT RD 106-129
GILBERT AZ
85295-8899
US

IV. Provider business mailing address

2487 S GILBERT RD 106-129
GILBERT AZ
85295-8899
US

V. Phone/Fax

Practice location:
  • Phone: 480-788-3793
  • Fax:
Mailing address:
  • Phone: 480-788-3793
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN151551
License Number StateAZ

VIII. Authorized Official

Name: JULIE A ANGILERI
Title or Position: OWNER
Credential: R.N.
Phone: 602-799-5958