Healthcare Provider Details

I. General information

NPI: 1740865989
Provider Name (Legal Business Name): DREAMCATCHER HOME CARE AND TRANSPORT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2021
Last Update Date: 03/30/2021
Certification Date: 03/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 NORTH NAVAJO ROUTE 673 WHIPPOORWILL
PINON AZ
86510
US

IV. Provider business mailing address

PO BOX 1212
PINON AZ
86510-1212
US

V. Phone/Fax

Practice location:
  • Phone: 928-725-2090
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: JORDAN WARTZ
Title or Position: PRESIDENT
Credential:
Phone: 928-725-2090