Healthcare Provider Details

I. General information

NPI: 1780005652
Provider Name (Legal Business Name): LOVING CARE AGENCY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2013
Last Update Date: 12/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8700 S KYRENE RD
TEMPE AZ
85284-2108
US

IV. Provider business mailing address

8700 S KYRENE RD
TEMPE AZ
85284-2108
US

V. Phone/Fax

Practice location:
  • Phone: 480-541-1000
  • Fax:
Mailing address:
  • Phone: 480-541-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License NumberLP040810
License Number StateAZ

VIII. Authorized Official

Name: LUKAEA EUNICE SABRINA TAYLOR
Title or Position: LICENSED PRACTICAL NURSE
Credential:
Phone: 602-931-7930