Healthcare Provider Details

I. General information

NPI: 1396596755
Provider Name (Legal Business Name): MEGAOASIS HOMECARE AGENCY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2024
Last Update Date: 04/01/2024
Certification Date: 04/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4514 W HASAN DR
LAVEEN AZ
85339-1959
US

IV. Provider business mailing address

3683 E NOLAN DR
CHANDLER AZ
85249-4697
US

V. Phone/Fax

Practice location:
  • Phone: 239-745-2517
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KEDHA ALCE
Title or Position: OWNER
Credential:
Phone: 239-745-2517