Healthcare Provider Details

I. General information

NPI: 1720734981
Provider Name (Legal Business Name): EZEKIEL'S HOUSE SENIOR SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/25/2022
Last Update Date: 02/25/2022
Certification Date: 02/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1904 W MOUNTAIN VIEW RD
PHOENIX AZ
85021-2118
US

IV. Provider business mailing address

1904 W MOUNTAIN VIEW RD
PHOENIX AZ
85021-2118
US

V. Phone/Fax

Practice location:
  • Phone: 602-726-5311
  • Fax:
Mailing address:
  • Phone: 602-726-5311
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code372500000X
TaxonomyChore Provider
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: MRS. SELENA AMERSON
Title or Position: OWNER
Credential:
Phone: 602-726-5311