Healthcare Provider Details

I. General information

NPI: 1134473416
Provider Name (Legal Business Name): CCFX,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2012
Last Update Date: 11/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2622 E JAVELINA CIR
MESA AZ
85204-7127
US

IV. Provider business mailing address

2622 E JAVELINA CIR
MESA AZ
85204-7127
US

V. Phone/Fax

Practice location:
  • Phone: 602-206-6999
  • Fax:
Mailing address:
  • Phone: 602-206-6999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QX0100X
TaxonomyOccupational Medicine Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. CHARYLE LOIS CALVERT
Title or Position: CEO
Credential: BSW
Phone: 602-206-6999