Healthcare Provider Details

I. General information

NPI: 1336937515
Provider Name (Legal Business Name): PLATINUM HOME CARE ARIZONA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2025
Last Update Date: 04/29/2025
Certification Date: 04/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4539 N 22ND ST STE R
PHOENIX AZ
85016-4639
US

IV. Provider business mailing address

1430 THRUSH AVE APT 8
ASHLAND CA
94578-2096
US

V. Phone/Fax

Practice location:
  • Phone: 510-306-2336
  • Fax:
Mailing address:
  • Phone: 510-978-5520
  • 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 Code376J00000X
TaxonomyHomemaker
License Number
License Number State

VIII. Authorized Official

Name: TALISA JOHNSON
Title or Position: MANAGER
Credential:
Phone: 510-978-5520