Healthcare Provider Details

I. General information

NPI: 1427640028
Provider Name (Legal Business Name): ABSOLUTE HCBS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2021
Last Update Date: 02/05/2021
Certification Date: 02/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4700 S MCCLINTOCK DR STE 150
TEMPE AZ
85282-7375
US

IV. Provider business mailing address

4700 S MCCLINTOCK DR STE 150
TEMPE AZ
85282-7375
US

V. Phone/Fax

Practice location:
  • Phone: 623-806-4040
  • Fax:
Mailing address:
  • Phone: 623-806-4040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: COURTNEY MISTICO
Title or Position: OWNER/CFO
Credential:
Phone: 623-806-4040