Healthcare Provider Details

I. General information

NPI: 1538039359
Provider Name (Legal Business Name): COREHEALTH FAMILY CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2025
Last Update Date: 11/06/2025
Certification Date: 11/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6751 N SUNSET BLVD STE 320
GLENDALE AZ
85305-3155
US

IV. Provider business mailing address

6751 N SUNSET BLVD STE 320
GLENDALE AZ
85305-3155
US

V. Phone/Fax

Practice location:
  • Phone: 207-409-8460
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LEEN NIZE
Title or Position: CEO
Credential:
Phone: 207-409-8460