Healthcare Provider Details

I. General information

NPI: 1316652332
Provider Name (Legal Business Name): FERVENT CARE SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2023
Last Update Date: 01/16/2023
Certification Date: 01/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4225 E UNIVERSITY DR APT 107
MESA AZ
85205-7092
US

IV. Provider business mailing address

4225 E UNIVERSITY DR APT 107
MESA AZ
85205-7092
US

V. Phone/Fax

Practice location:
  • Phone: 763-923-1475
  • Fax:
Mailing address:
  • Phone: 763-923-1475
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State

VIII. Authorized Official

Name: LUCKY IDA IGBINOBA
Title or Position: CEO
Credential:
Phone: 763-723-1475