Healthcare Provider Details

I. General information

NPI: 1730441247
Provider Name (Legal Business Name): REPRIEVE HOME CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2012
Last Update Date: 06/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6020 W SUNNYSIDE DR
GLENDALE AZ
85304-2532
US

IV. Provider business mailing address

6020 W SUNNYSIDE DR
GLENDALE AZ
85304-2532
US

V. Phone/Fax

Practice location:
  • Phone: 623-203-3087
  • Fax: 623-266-9167
Mailing address:
  • Phone: 623-203-3087
  • Fax: 623-266-9167

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number500006419
License Number StateAZ

VIII. Authorized Official

Name: MRS. AMY LYNN MACRI
Title or Position: OWNER
Credential:
Phone: 623-203-3087