Healthcare Provider Details

I. General information

NPI: 1518648336
Provider Name (Legal Business Name): CHEMICHEMI FAMILY LIFE COUNSELING SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2023
Last Update Date: 12/19/2023
Certification Date: 12/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10240 W BELL RD
SUN CITY AZ
85351-1153
US

IV. Provider business mailing address

10240 W BELL RD
SUN CITY AZ
85351-1153
US

V. Phone/Fax

Practice location:
  • Phone: 623-213-8192
  • Fax:
Mailing address:
  • Phone: 623-213-8192
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: PATRICIA KIMANI
Title or Position: ADMINISTRATOR
Credential: BSN/RN
Phone: 623-866-2451