Healthcare Provider Details

I. General information

NPI: 1235885765
Provider Name (Legal Business Name): FAMILY HOME HEALTH & HOSPICE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2022
Last Update Date: 11/11/2025
Certification Date: 11/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 N CENTENNIAL WAY STE 150
MESA AZ
85201-6689
US

IV. Provider business mailing address

123 N CENTENNIAL WAY STE 150
MESA AZ
85201-6689
US

V. Phone/Fax

Practice location:
  • Phone: 480-695-2881
  • Fax:
Mailing address:
  • Phone: 480-695-2881
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name: DR. JONATHAN ROBERT VANCE
Title or Position: OWNER/PRESIDENT
Credential: DPT, PT
Phone: 480-695-2881