Healthcare Provider Details

I. General information

NPI: 1811296262
Provider Name (Legal Business Name): BECKY HOME HEALTH CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2011
Last Update Date: 03/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16551 N DYSART RD STE 104A
SURPRISE AZ
85378-3707
US

IV. Provider business mailing address

16551 N. DYSART ROAD, SUITE 104A
SURPRISE AZ
85374
US

V. Phone/Fax

Practice location:
  • Phone: 623-455-8777
  • Fax: 623-414-3078
Mailing address:
  • Phone: 623-455-8777
  • Fax: 623-414-3078

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number StateAZ
# 4
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number StateAZ
# 5
Primary TaxonomyN
Taxonomy Code385HR2055X
TaxonomyChild Mental Illness Respite Care
License Number
License Number StateAZ
# 6
Primary TaxonomyN
Taxonomy Code385HR2065X
TaxonomyChild Physical Disabilities Respite Care
License Number
License Number StateAZ
# 7
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateAZ

VIII. Authorized Official

Name: MR. NATHAN K AGURU
Title or Position: CHIEF ADMINISTRATOR
Credential: MBA
Phone: 623-455-8777