Healthcare Provider Details

I. General information

NPI: 1235913385
Provider Name (Legal Business Name): SAGUARO CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2023
Last Update Date: 12/27/2023
Certification Date: 12/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11201 N TATUM BLVD STE 315
PHOENIX AZ
85028-6039
US

IV. Provider business mailing address

10645 N TATUM BLVD. STE. 200. #509
PHOENIX AZ
85028
US

V. Phone/Fax

Practice location:
  • Phone: 602-313-3991
  • Fax:
Mailing address:
  • Phone: 503-580-6378
  • 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 Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name: RONALD CLARK
Title or Position: OWNER
Credential:
Phone: 503-580-6378