Healthcare Provider Details

I. General information

NPI: 1639449010
Provider Name (Legal Business Name): SUPABILINGUALTHERAPYSERVICES.LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2012
Last Update Date: 11/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2615 N CHAMPLAIN AVE
TEMPE AZ
85281-7905
US

IV. Provider business mailing address

2615 N CHAMPLAIN AVE
TEMPE AZ
85281-7905
US

V. Phone/Fax

Practice location:
  • Phone: 623-237-1922
  • Fax:
Mailing address:
  • Phone: 623-237-1922
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. MARVAH D'AQUINO
Title or Position: OWNER
Credential:
Phone: 623-237-1922