Healthcare Provider Details

I. General information

NPI: 1619518263
Provider Name (Legal Business Name): DALIA HOMECARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2019
Last Update Date: 05/18/2021
Certification Date: 05/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

426 W BEAUTIFUL LN
PHOENIX AZ
85041-8013
US

IV. Provider business mailing address

426 W BEAUTIFUL LN
PHOENIX AZ
85041-8013
US

V. Phone/Fax

Practice location:
  • Phone: 612-735-9836
  • Fax:
Mailing address:
  • Phone: 612-735-9836
  • Fax: 602-607-5636

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: DARIUS COX
Title or Position: CEO
Credential:
Phone: 612-735-9836