Healthcare Provider Details

I. General information

NPI: 1730765066
Provider Name (Legal Business Name): UNMERITED FAVOR SPECIAL CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2021
Last Update Date: 06/21/2022
Certification Date: 06/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

719 E DENIM TRL
SAN TAN VLY AZ
85143-6131
US

IV. Provider business mailing address

719 E DENIM TRL
SAN TAN VLY AZ
85143-6131
US

V. Phone/Fax

Practice location:
  • Phone: 614-260-9737
  • Fax:
Mailing address:
  • Phone: 614-260-9737
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: DR. EDMUND SEKYI EGHAN
Title or Position: MEMBER/OWNER
Credential: DR.
Phone: 614-260-9737