Healthcare Provider Details

I. General information

NPI: 1841834199
Provider Name (Legal Business Name): GERIHEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2019
Last Update Date: 10/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3530 S VAL VISTA DR STE B210
GILBERT AZ
85297-7318
US

IV. Provider business mailing address

3530 S VAL VISTA DR STE B210
GILBERT AZ
85297-7318
US

V. Phone/Fax

Practice location:
  • Phone: 480-359-3998
  • Fax: 480-385-6785
Mailing address:
  • Phone: 480-359-3998
  • Fax: 480-385-6785

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MAI SHANNON
Title or Position: CEO
Credential:
Phone: 480-359-3998