Healthcare Provider Details

I. General information

NPI: 1265947980
Provider Name (Legal Business Name): CPLC HOME HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2017
Last Update Date: 01/24/2023
Certification Date: 07/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1617 N 45TH AVE APT A102
PHOENIX AZ
85035-4220
US

IV. Provider business mailing address

1617 N 45TH AVE APT A102
PHOENIX AZ
85035-4220
US

V. Phone/Fax

Practice location:
  • Phone: 602-442-9548
  • Fax: 602-269-0621
Mailing address:
  • Phone: 602-442-9548
  • Fax: 602-269-0621

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: AMANDA DAWN COLEMAN
Title or Position: DIRECTOR OF HOME HEALTHCARE
Credential: RN
Phone: 602-442-9548