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General NPI Number Information
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NPI Number | 1205508405
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Entity Type | Organization
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Legal Business Name | BVO PROFESSIONAL SERVICES, LLC
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Dates
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Enumeration Date | 10/05/2021
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Last Update Date | 10/05/2021
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Provider Practice Location Address
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Address Line | 17769 W CASSIA WAY
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City | GOODYEAR
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State | AZ
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Zip | 85338-6430
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Country | US
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Telephone | 480-462-1047
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Fax |
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Provider Business Mailing Address
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Address Line | 875 S ESTRELLA PARKWAY #7592
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City | GOODYEAR
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State | AZ
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Zip | 85338
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | BRYAN ONUSELOGU
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Credential |
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Telephone | 480-462-1047
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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