Healthcare Provider Details

I. General information

NPI: 1427761659
Provider Name (Legal Business Name): NATIVE FAMILY HOMECARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2023
Last Update Date: 01/03/2023
Certification Date: 01/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3234 W FREMONT RD
PHOENIX AZ
85041-6591
US

IV. Provider business mailing address

3234 W FREMONT RD
PHOENIX AZ
85041-6591
US

V. Phone/Fax

Practice location:
  • Phone: 480-865-5244
  • Fax:
Mailing address:
  • Phone: 480-865-5244
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: TYRESE TOMEGAH
Title or Position: MANAGER
Credential:
Phone: 480-865-5244