Healthcare Provider Details

I. General information

NPI: 1043725427
Provider Name (Legal Business Name): SUNSET HOME CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2017
Last Update Date: 12/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2902 W SWEETWATER AVE APT 1151
PHOENIX AZ
85029-1393
US

IV. Provider business mailing address

2902 W SWEETWATER AVE APT 1151
PHOENIX AZ
85029-1393
US

V. Phone/Fax

Practice location:
  • Phone: 602-420-3868
  • Fax: 928-438-3333
Mailing address:
  • Phone: 602-420-3868
  • Fax: 928-438-3333

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number StateAZ

VIII. Authorized Official

Name: ERICKA WHITE
Title or Position: OWNER
Credential:
Phone: 602-420-3868