Healthcare Provider Details

I. General information

NPI: 1275797169
Provider Name (Legal Business Name): PHOENIX VALLEY SENIOR CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2008
Last Update Date: 07/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1450 W GUADALUPE RD STE 115
GILBERT AZ
85233-3042
US

IV. Provider business mailing address

1450 W GUADALUPE RD STE 115
GILBERT AZ
85233-3042
US

V. Phone/Fax

Practice location:
  • Phone: 480-632-1100
  • Fax: 480-632-0230
Mailing address:
  • Phone: 480-632-1100
  • Fax: 480-632-0230

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State

VIII. Authorized Official

Name: MISS SHERRI LYNN TAYLOR
Title or Position: OWNER
Credential: RN
Phone: 480-632-1100