Healthcare Provider Details

I. General information

NPI: 1538850268
Provider Name (Legal Business Name): NECKUP CHECKUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2023
Last Update Date: 05/15/2023
Certification Date: 05/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5130 E WARNER RD
PHOENIX AZ
85044-3363
US

IV. Provider business mailing address

2030 W BASELINE RD # 182-150
PHOENIX AZ
85041-6574
US

V. Phone/Fax

Practice location:
  • Phone: 480-227-6984
  • Fax:
Mailing address:
  • Phone: 480-227-6984
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code405300000X
TaxonomyPrevention Professional
License Number
License Number State

VIII. Authorized Official

Name: MRS. JORONDA AISHA MONTANO
Title or Position: CEO
Credential: MPA
Phone: 480-227-6984