Healthcare Provider Details

I. General information

NPI: 1750046769
Provider Name (Legal Business Name): MY AGING SENIORS KEEPER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2021
Last Update Date: 11/04/2021
Certification Date: 11/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34000 N 27TH DR UNIT 2118
PHOENIX AZ
85085-6642
US

IV. Provider business mailing address

34000 N 27TH DR UNIT 2118
PHOENIX AZ
85085-6642
US

V. Phone/Fax

Practice location:
  • Phone: 480-803-4713
  • Fax:
Mailing address:
  • Phone: 480-803-4713
  • 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 Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: ANDREA GREER
Title or Position: OWNER
Credential:
Phone: 480-803-4713