Healthcare Provider Details

I. General information

NPI: 1134643968
Provider Name (Legal Business Name): HUMAN ARC CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2017
Last Update Date: 08/29/2023
Certification Date: 08/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2010 W WHISPERING WIND DR STE 101
PHOENIX AZ
85085-2847
US

IV. Provider business mailing address

2010 W WHISPERING WIND DR STE 101
PHOENIX AZ
85085-2847
US

V. Phone/Fax

Practice location:
  • Phone: 623-582-8722
  • Fax:
Mailing address:
  • Phone: 623-582-8722
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. JEFFREY A JACKSON
Title or Position: COO
Credential:
Phone: 602-821-2972