Healthcare Provider Details

I. General information

NPI: 1821444894
Provider Name (Legal Business Name): CHP CARE, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2016
Last Update Date: 07/18/2022
Certification Date: 07/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25812 N 67TH DR
PEORIA AZ
85383-7135
US

IV. Provider business mailing address

25812 N 67TH DR
PEORIA AZ
85383-7135
US

V. Phone/Fax

Practice location:
  • Phone: 602-332-3363
  • Fax:
Mailing address:
  • Phone: 602-332-3363
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MARC LEIB
Title or Position: CEO
Credential: M.D.
Phone: 602-708-8455