Healthcare Provider Details

I. General information

NPI: 1720524333
Provider Name (Legal Business Name): MD HOMECARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2017
Last Update Date: 07/05/2023
Certification Date: 07/05/2023
Deactivation Date: 06/02/2023
Reactivation Date: 07/05/2023

III. Provider practice location address

9225 N 3RD ST STE 102
PHOENIX AZ
85020-2455
US

IV. Provider business mailing address

9225 N 3RD ST STE 102
PHOENIX AZ
85020-2455
US

V. Phone/Fax

Practice location:
  • Phone: 602-362-2983
  • Fax: 480-565-4552
Mailing address:
  • Phone: 602-362-2983
  • Fax: 480-565-4552

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MOHAMED KHALIL
Title or Position: CEO
Credential:
Phone: 602-362-2983