Healthcare Provider Details

I. General information

NPI: 1821564303
Provider Name (Legal Business Name): PARADISE VALLEY LOVING CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/22/2018
Last Update Date: 10/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3324 E ORAIBI DR
PHOENIX AZ
85050-3979
US

IV. Provider business mailing address

3324 E ORAIBI DR
PHOENIX AZ
85050-3979
US

V. Phone/Fax

Practice location:
  • Phone: 602-992-8942
  • Fax:
Mailing address:
  • Phone: 602-992-8942
  • 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 Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name: MRS. LYDIA SIMON
Title or Position: OWNER
Credential:
Phone: 602-647-7514