Healthcare Provider Details

I. General information

NPI: 1043029549
Provider Name (Legal Business Name): MY CITY RADIUS COMMUNITY HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/31/2024
Last Update Date: 12/31/2024
Certification Date: 12/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6125 S ASH AVE # SUITEB6
TEMPE AZ
85283-5624
US

IV. Provider business mailing address

6125 S ASH AVE # SUITEB6
TEMPE AZ
85283-5624
US

V. Phone/Fax

Practice location:
  • Phone: 480-651-6458
  • Fax:
Mailing address:
  • Phone: 480-651-6458
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code253J00000X
TaxonomyFoster Care Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: FAVOR CHIKELU
Title or Position: ADMINISTRATOR
Credential:
Phone: 480-651-6458