Healthcare Provider Details

I. General information

NPI: 1467225995
Provider Name (Legal Business Name): MY HOME HEALTHCARE AGENCY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2023
Last Update Date: 11/06/2023
Certification Date: 11/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19532 N 27TH PL
PHOENIX AZ
85050-1308
US

IV. Provider business mailing address

19532 N 27TH PL
PHOENIX AZ
85050-1308
US

V. Phone/Fax

Practice location:
  • Phone: 602-666-0202
  • Fax: 602-844-5455
Mailing address:
  • Phone: 602-888-6779
  • Fax:

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 Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number State

VIII. Authorized Official

Name: ROSALYN YOUNG
Title or Position: CEO/ADMINISTRATOR
Credential:
Phone: 26-666-0202