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General NPI Number Information
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NPI Number | 1366215105
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Entity Type | Organization
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Legal Business Name | CHOICE HOME HEATH AGENCY LLC
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Dates
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Enumeration Date | 11/02/2023
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Last Update Date | 11/02/2023
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Provider Practice Location Address
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Address Line | 14040 N CAVE CREEK RD STE 101D
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City | PHOENIX
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State | AZ
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Zip | 85022-6118
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Country | US
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Telephone | 480-273-9889
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Fax | 480-626-0630
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Provider Business Mailing Address
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Address Line | 10357 W HARMONY LN
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City | PEORIA
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State | AZ
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Zip | 85382-5901
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Country | US
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Telephone | 480-273-9889
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Fax | 480-626-0630
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Authorized Official
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Title or Position | CEO
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Name | BLASIOUS MABODO MASHATISA
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Credential |
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Telephone | 480-273-9889
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 374U00000X
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Taxonomy Name | Home Health Aide
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License Number |
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License Number State |
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