Healthcare Provider Details

I. General information

NPI: 1013365493
Provider Name (Legal Business Name): GERI-CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2016
Last Update Date: 06/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6414 E JUNIPER AVE
SCOTTSDALE AZ
85254-1401
US

IV. Provider business mailing address

6414 E JUNIPER AVE
SCOTTSDALE AZ
85254-1401
US

V. Phone/Fax

Practice location:
  • Phone: 480-991-3775
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2821
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number2821
License Number StateAZ

VIII. Authorized Official

Name: DR. PAUL LAVEN
Title or Position: MEMBER/OWNER
Credential: DO
Phone: 480-395-1780