Healthcare Provider Details

I. General information

NPI: 1174046478
Provider Name (Legal Business Name): YOUR ANGEL ON DUTY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2017
Last Update Date: 07/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4747 E ELLIOT RD #29-460
PHOENIX AZ
85040
US

IV. Provider business mailing address

4747 E ELLIOT RD # 29-460
PHOENIX AZ
85044-1627
US

V. Phone/Fax

Practice location:
  • Phone: 480-352-1461
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateAZ

VIII. Authorized Official

Name: MICHELE SANFORD-BOOTH
Title or Position: OWNER
Credential:
Phone: 480-352-1461