Healthcare Provider Details

I. General information

NPI: 1528757648
Provider Name (Legal Business Name): ISAMBULO HOME HEALTH CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2023
Last Update Date: 12/18/2023
Certification Date: 12/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6024 E MCKELLIPS RD STE 1
MESA AZ
85215-2829
US

IV. Provider business mailing address

6024 E MCKELLIPS RD STE 1
MESA AZ
85215-2829
US

V. Phone/Fax

Practice location:
  • Phone: 951-966-0193
  • Fax:
Mailing address:
  • Phone: 951-966-0193
  • 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 Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name: ELLEN MUSAKWA
Title or Position: PRESIDENT/ADMIN
Credential:
Phone: 951-966-0193