Healthcare Provider Details

I. General information

NPI: 1699135483
Provider Name (Legal Business Name): MODERN HEALTHCARE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2016
Last Update Date: 07/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3201 W PEORIA AVE STE A105
PHOENIX AZ
85029-4609
US

IV. Provider business mailing address

2942 N 24TH ST STE 114
PHOENIX AZ
85016-7849
US

V. Phone/Fax

Practice location:
  • Phone: 602-699-6353
  • Fax: 602-699-6354
Mailing address:
  • Phone: 602-699-6353
  • Fax: 602-699-6354

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number41767
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number7417
License Number StateAZ
# 4
Primary TaxonomyN
Taxonomy Code163WA0400X
TaxonomyAddiction (Substance Use Disorder) Registered Nurse
License NumberRN198428
License Number StateAZ
# 5
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP8585
License Number StateAZ

VIII. Authorized Official

Name: MATTHEW MICHAEL RHODES
Title or Position: PRESIDENT
Credential: NP
Phone: 602-699-6353