Healthcare Provider Details

I. General information

NPI: 1356269641
Provider Name (Legal Business Name): AUTUMNS HEART HOME CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2026
Last Update Date: 07/06/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8902 N 19TH AVE
PHOENIX AZ
85021-4287
US

IV. Provider business mailing address

8902 N 19TH AVE APT 2086
PHOENIX AZ
85021-6008
US

V. Phone/Fax

Practice location:
  • Phone: 623-456-2278
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: TAJHANAE RENNEA DANIELS
Title or Position: OWNER
Credential:
Phone: 623-456-2278