Healthcare Provider Details

I. General information

NPI: 1033145495
Provider Name (Legal Business Name): GERIATRIC SOLUTIONS - HOV, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2006
Last Update Date: 04/30/2019
Certification Date:
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: 602-954-0444
  • Fax: 602-952-7146
Mailing address:
  • Phone: 602-954-0444
  • Fax: 602-952-7146

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number22105
License Number StateAZ

VIII. Authorized Official

Name: MRS. DEBORAH SHUMWAY
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 602-530-6900