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General NPI Number Information
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NPI Number | 1164174272
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Entity Type | Organization
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Legal Business Name | ADULT GERIATRIC CARE GROUP
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Dates
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Enumeration Date | 01/20/2022
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Last Update Date | 05/30/2023
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Provider Practice Location Address
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Address Line | 12451 W GENTLE RAIN RD
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City | PEORIA
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State | AZ
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Zip | 85383-7198
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Country | US
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Telephone | 857-400-7436
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Fax | 888-425-0427
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Provider Business Mailing Address
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Address Line | 20403 N LAKE PLEASANT RD STE 117-488
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City | PEORIA
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State | AZ
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Zip | 85382-9702
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Country | US
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Telephone | 857-400-7436
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Fax | 888-425-0427
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Authorized Official
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Title or Position | NURSE PRACTITIONER/OWNER
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Name | MR. AMORY GODWIN CARINGAL GRIJALDO
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Credential | AGACNP-BC
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Telephone | 602-687-3273
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number |
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License Number State |
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