Healthcare Provider Details

I. General information

NPI: 1679074231
Provider Name (Legal Business Name): CAREMEDIX HOME HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2018
Last Update Date: 02/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1555 E UNIVERSITY DR STE 4
MESA AZ
85203-8142
US

IV. Provider business mailing address

10317 E JEROME AVE
MESA AZ
85209-7746
US

V. Phone/Fax

Practice location:
  • Phone: 480-255-6540
  • Fax: 480-834-4181
Mailing address:
  • Phone: 480-213-7845
  • Fax: 480-834-4181

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:

VIII. Authorized Official

Name: MR. THEODORE A MOGOL
Title or Position: ADMINISTRATOR
Credential:
Phone: 480-255-6540