Healthcare Provider Details

I. General information

NPI: 1124917034
Provider Name (Legal Business Name): SACRED KIN COMPANIONS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2025
Last Update Date: 07/06/2025
Certification Date: 07/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4483 S LEISURE WAY
GILBERT AZ
85297-0883
US

IV. Provider business mailing address

4483 S LEISURE WAY
GILBERT AZ
85297-0883
US

V. Phone/Fax

Practice location:
  • Phone: 602-448-3074
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code374K00000X
TaxonomyReligious Nonmedical Practitioner
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name: TARANEISHA WOODS-REYES
Title or Position: CEO
Credential:
Phone: 602-448-3074