Healthcare Provider Details

I. General information

NPI: 1437318847
Provider Name (Legal Business Name): AT YOUR DOOR ELDERCARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2008
Last Update Date: 07/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17035 N 67TH AVE SUITE 11
GLENDALE AZ
85308-4511
US

IV. Provider business mailing address

17035 N 67TH AVE SUITE 11
GLENDALE AZ
85308-4511
US

V. Phone/Fax

Practice location:
  • Phone: 623-878-2885
  • Fax: 623-878-6512
Mailing address:
  • Phone: 623-878-2885
  • Fax: 623-878-6512

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MS. REBECCA DANIELLE TANNER
Title or Position: OWNER
Credential:
Phone: 623-878-2885