Healthcare Provider Details

I. General information

NPI: 1801565544
Provider Name (Legal Business Name): TITUS WAITITU NJUGUNA CERTIFIED CAREGIVER,
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: TITUS WAITITU NJUGUNA MANAGER GROUPHOMES

II. Dates (important events)

Enumeration Date: 09/07/2021
Last Update Date: 09/07/2021
Certification Date: 09/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2010 W BRANHAM LN
PHOENIX AZ
85041-7718
US

IV. Provider business mailing address

2010 W BRANHAM LN
PHOENIX AZ
85041-7718
US

V. Phone/Fax

Practice location:
  • Phone: 469-254-3912
  • Fax:
Mailing address:
  • Phone: 469-254-3912
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License NumberAZ12788
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: