Healthcare Provider Details

I. General information

NPI: 1710279385
Provider Name (Legal Business Name): ARIZONA SUPPORTIVE CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2011
Last Update Date: 12/14/2020
Certification Date: 12/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1510 E FLOWER ST
PHOENIX AZ
85014-5698
US

IV. Provider business mailing address

1510 E FLOWER ST
PHOENIX AZ
85014-5698
US

V. Phone/Fax

Practice location:
  • Phone: 602-530-6900
  • Fax: 602-530-6902
Mailing address:
  • Phone: 602-530-6900
  • Fax: 602-530-6902

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number State

VIII. Authorized Official

Name: DEBBIE SHUMWAY
Title or Position: PRESIDENT / CEO
Credential:
Phone: 602-530-6900