Healthcare Provider Details

I. General information

NPI: 1689303117
Provider Name (Legal Business Name): ANGELS VALLEY COMMUNITY HEALTHCARE CENTER PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2022
Last Update Date: 09/21/2024
Certification Date: 09/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14820 N CAVE CREEK RD STE 2
PHOENIX AZ
85032-4951
US

IV. Provider business mailing address

14820 N CAVE CREEK RD STE 2
PHOENIX AZ
85032-4951
US

V. Phone/Fax

Practice location:
  • Phone: 833-242-0100
  • Fax:
Mailing address:
  • Phone: 833-242-0100
  • Fax: 623-889-0814

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name: JEAN SIMON JOEL EDOUARD
Title or Position: CEO
Credential: PA, SA-C
Phone: 520-527-8038