Healthcare Provider Details

I. General information

NPI: 1013729953
Provider Name (Legal Business Name): ODELLA HOME CARE SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2025
Last Update Date: 04/13/2025
Certification Date: 04/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11201 N TATUM BLVD
PHOENIX AZ
85028-6036
US

IV. Provider business mailing address

11201 N TATUM BLVD
PHOENIX AZ
85028-6036
US

V. Phone/Fax

Practice location:
  • Phone: 623-800-7889
  • Fax:
Mailing address:
  • Phone: 623-800-7889
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: ANITRA DAVIS
Title or Position: OWNER
Credential:
Phone: 623-800-7889