Healthcare Provider Details

I. General information

NPI: 1336911734
Provider Name (Legal Business Name): KI-EZY CHANGES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2023
Last Update Date: 11/01/2023
Certification Date: 11/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

736 S CATALINA ST
GILBERT AZ
85233-7333
US

IV. Provider business mailing address

736 S CATALINA ST
GILBERT AZ
85233-7333
US

V. Phone/Fax

Practice location:
  • Phone: 646-400-4558
  • Fax: 623-273-2586
Mailing address:
  • Phone: 646-400-4558
  • Fax: 623-273-2586

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State

VIII. Authorized Official

Name: TANAH KIZITO
Title or Position: CEO
Credential:
Phone: 646-400-4558