Healthcare Provider Details

I. General information

NPI: 1346499324
Provider Name (Legal Business Name): CENTURY CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2008
Last Update Date: 11/21/2024
Certification Date: 11/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7227 E BASELINE RD STE 126
MESA AZ
85209-5006
US

IV. Provider business mailing address

7227 E BASELINE RD STE 126
MESA AZ
85209-5006
US

V. Phone/Fax

Practice location:
  • Phone: 480-868-9650
  • Fax: 480-834-3606
Mailing address:
  • Phone: 480-868-9650
  • Fax: 480-834-3606

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number12301
License Number StateAZ
# 5
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: GREGORY CHAD MANGUM
Title or Position: OWNER
Credential:
Phone: 435-514-5646