Healthcare Provider Details

I. General information

NPI: 1477148351
Provider Name (Legal Business Name): LIVING FREE TO BE US HOUSING AND HOME CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2021
Last Update Date: 03/03/2021
Certification Date: 03/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10401 N CAVE CREEK RD LOT 310
PHOENIX AZ
85020-1601
US

IV. Provider business mailing address

10401 N CAVE CREEK RD LOT 310
PHOENIX AZ
85020-1601
US

V. Phone/Fax

Practice location:
  • Phone: 623-221-3625
  • Fax:
Mailing address:
  • Phone: 623-221-3625
  • Fax:

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: BEVERLY A PETERSON
Title or Position: PRACTICE OWNER
Credential: LNA
Phone: 623-221-3625