Healthcare Provider Details

I. General information

NPI: 1356680938
Provider Name (Legal Business Name): JIRALOGIC, LLC DBA FIRSTLIGHT HOMECARE OF SCOTTSDALE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2013
Last Update Date: 02/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7585 E REDFIELD RD #105
SCOTTSDALE AZ
85260-6936
US

IV. Provider business mailing address

7585 E REDFIELD RD #105
SCOTTSDALE AZ
85260-6936
US

V. Phone/Fax

Practice location:
  • Phone: 480-922-2820
  • Fax: 480-452-0403
Mailing address:
  • Phone: 480-922-2820
  • Fax: 480-452-0403

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number1077172
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code311Z00000X
TaxonomyCustodial Care Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. JIM R CREWS
Title or Position: PRESIDENT/OWNER
Credential:
Phone: 480-922-2820