Healthcare Provider Details

I. General information

NPI: 1144541558
Provider Name (Legal Business Name): AFFECTIONATE PROFESSIONAL HOME CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2010
Last Update Date: 06/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3886 S DEW DROP LN
GILBERT AZ
85297-8033
US

IV. Provider business mailing address

3886 S DEW DROP LN
GILBERT AZ
85297-8033
US

V. Phone/Fax

Practice location:
  • Phone: 602-565-9404
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. I J TELFER
Title or Position: PRESIDENT
Credential:
Phone: 602-565-9404