Healthcare Provider Details

I. General information

NPI: 1710694070
Provider Name (Legal Business Name): SHIRLEY GAINES-ROBINSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/04/2022
Last Update Date: 11/04/2022
Certification Date: 11/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14819 N CAVE CREEK RD
PHOENIX AZ
85032-4986
US

IV. Provider business mailing address

46008 W BELLE AVE
MARICOPA AZ
85139-6989
US

V. Phone/Fax

Practice location:
  • Phone: 480-744-5478
  • Fax:
Mailing address:
  • Phone: 219-561-3465
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number146731
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: