Healthcare Provider Details

I. General information

NPI: 1699261982
Provider Name (Legal Business Name): CHEVICK FAMILY HOMECARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2018
Last Update Date: 07/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 E BASELINE RD
TEMPE AZ
85283-1247
US

IV. Provider business mailing address

600 E BASELINE RD
TEMPE AZ
85283-1247
US

V. Phone/Fax

Practice location:
  • Phone: 480-508-4924
  • Fax:
Mailing address:
  • Phone: 480-508-4924
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberOTC8923
License Number StateAZ

VIII. Authorized Official

Name: VICTOR OGOTI
Title or Position: PRESIDENT
Credential:
Phone: 480-508-4924