Healthcare Provider Details

I. General information

NPI: 1255792826
Provider Name (Legal Business Name): AFFILIATED HEARING CARE CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2016
Last Update Date: 03/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5620 W THUNDERBIRD RD G2
GLENDALE AZ
85306-4636
US

IV. Provider business mailing address

5620 W THUNDERBIRD RD G2
GLENDALE AZ
85306-4636
US

V. Phone/Fax

Practice location:
  • Phone: 602-938-6960
  • Fax: 602-938-6069
Mailing address:
  • Phone: 602-938-6960
  • Fax: 602-938-6069

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332S00000X
TaxonomyHearing Aid Equipment
License Number
License Number State

VIII. Authorized Official

Name: BRIAN RIVELAND
Title or Position: CEO
Credential: MD
Phone: 602-938-6960