Healthcare Provider Details

I. General information

NPI: 1063835973
Provider Name (Legal Business Name): ALL HOME CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/28/2014
Last Update Date: 02/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3101 N CENTRAL AVE SUITE 160
PHOENIX AZ
85012-2645
US

IV. Provider business mailing address

3101 N CENTRAL AVE SUITE 160
PHOENIX AZ
85012-2645
US

V. Phone/Fax

Practice location:
  • Phone: 602-626-8345
  • Fax: 602-626-8840
Mailing address:
  • Phone: 602-626-8345
  • Fax: 602-626-8840

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. DEBORAH M GIDEON
Title or Position: CLINICAL DIRECTOR
Credential: RN
Phone: 602-505-3272