Healthcare Provider Details

I. General information

NPI: 1346388444
Provider Name (Legal Business Name): ENDREDY ENTERPRISES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2007
Last Update Date: 05/04/2023
Certification Date: 05/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1855 W BASELINE RD STE 202
MESA AZ
85202-9010
US

IV. Provider business mailing address

1855 W BASELINE RD STE 202
MESA AZ
85202-9010
US

V. Phone/Fax

Practice location:
  • Phone: 480-377-6770
  • Fax: 480-377-6763
Mailing address:
  • Phone: 480-377-6770
  • Fax: 480-377-6763

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier967292
Identifier TypeMEDICAID
Identifier StateAZ
Identifier Issuer

VIII. Authorized Official

Name: MR. MICHAEL MARK ENDREDY
Title or Position: MANAGING MEMBER
Credential:
Phone: 480-377-6770