Healthcare Provider Details

I. General information

NPI: 1154293678
Provider Name (Legal Business Name): CARECHOICE AZ LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2025
Last Update Date: 09/23/2025
Certification Date: 09/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8101 WASHINGTON LN STE 200
WYNCOTE PA
19095-1625
US

IV. Provider business mailing address

8101 WASHINGTON LN STE 200
WYNCOTE PA
19095-1625
US

V. Phone/Fax

Practice location:
  • Phone: 215-277-0000
  • Fax:
Mailing address:
  • Phone: 215-277-0000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: ARSEN USTAYEV
Title or Position: CEO
Credential:
Phone: 215-277-0000