Healthcare Provider Details

I. General information

NPI: 1861752958
Provider Name (Legal Business Name): TRANS AID LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2012
Last Update Date: 05/22/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4617 W VENTURE CT
PHOENIX AZ
85086-1421
US

IV. Provider business mailing address

4617 W VENTURE CT
PHOENIX AZ
85086-1421
US

V. Phone/Fax

Practice location:
  • Phone: 623-215-8821
  • Fax:
Mailing address:
  • Phone: 623-215-8821
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License NumberD00779436
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License NumberD00779436
License Number StateAZ

VIII. Authorized Official

Name: RITA KANETCHDJIAN
Title or Position: OWNER
Credential:
Phone: 602-793-9694