Healthcare Provider Details

I. General information

NPI: 1952761561
Provider Name (Legal Business Name): CARING FOUR GENERATIONS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/25/2016
Last Update Date: 02/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5028 N 39TH AVE
PHOENIX AZ
85019-2508
US

IV. Provider business mailing address

5028 N 39TH AVE
PHOENIX AZ
85019-2508
US

V. Phone/Fax

Practice location:
  • Phone: 602-510-3571
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: WALESCA I SANTIAGO
Title or Position: MANAGER
Credential:
Phone: 602-510-3571