Healthcare Provider Details

I. General information

NPI: 1275300212
Provider Name (Legal Business Name): ABIDING COMFORT HOMECARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2023
Last Update Date: 03/13/2024
Certification Date: 03/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

PO BOX 21864
LITTLE ROCK AR
72221-1864
US

V. Phone/Fax

Practice location:
  • Phone: 602-641-2024
  • Fax: 602-641-2022
Mailing address:
  • Phone: 602-641-2024
  • Fax: 602-641-2022

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 Code251F00000X
TaxonomyHome Infusion Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: MIKERRAH M WILSON
Title or Position: CEO
Credential:
Phone: 602-641-2024