Healthcare Provider Details

I. General information

NPI: 1588447478
Provider Name (Legal Business Name): JANNIC HOME CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2023
Last Update Date: 11/26/2024
Certification Date: 11/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12610 N CAVE CREEK ROAD SUITE 113
PHOENIX AZ
85022-6515
US

IV. Provider business mailing address

12601 N CAVE CREEK RD STE 113
PHOENIX AZ
85022-6517
US

V. Phone/Fax

Practice location:
  • Phone: 602-699-4758
  • Fax: 602-699-4869
Mailing address:
  • Phone: 602-699-4758
  • Fax: 602-699-4869

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 Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: MR. JONN D'MARTIN
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 602-699-4758