Healthcare Provider Details

I. General information

NPI: 1609644814
Provider Name (Legal Business Name): SOUTHWEST RENAL CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2023
Last Update Date: 03/25/2026
Certification Date: 03/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

809 W LONGHORN RD
PAYSON AZ
85541-4280
US

IV. Provider business mailing address

9977 N 90TH ST STE 160
SCOTTSDALE AZ
85258-4499
US

V. Phone/Fax

Practice location:
  • Phone: 480-435-6106
  • Fax:
Mailing address:
  • Phone: 480-435-6106
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BD1200X
TaxonomyDialysis Equipment & Supplies (DME)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2472R0900X
TaxonomyRenal Dialysis Technician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QE0700X
TaxonomyEnd-Stage Renal Disease (ESRD) Treatment Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JUSTIN STRICKLAND
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 480-435-6106