Healthcare Provider Details

I. General information

NPI: 1831864677
Provider Name (Legal Business Name): VANWARD CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2021
Last Update Date: 08/13/2021
Certification Date: 08/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4114 E LIBERTY LN
PHOENIX AZ
85048-0530
US

IV. Provider business mailing address

15345 W ROMA AVE
GOODYEAR AZ
85395-6354
US

V. Phone/Fax

Practice location:
  • Phone: 815-520-3658
  • Fax:
Mailing address:
  • Phone: 815-520-3658
  • 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: MR. JOHN NOEL EARHART II
Title or Position: OWNER
Credential:
Phone: 815-520-3658