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General NPI Number Information
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NPI Number | 1376908996
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Entity Type | Organization
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Legal Business Name | WESTCHESTER TBI HOME CARE LLC
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Dates
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Enumeration Date | 12/25/2015
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Last Update Date | 12/25/2015
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Provider Practice Location Address
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Address Line | 1046 E WESTCHESTER DR
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City | TEMPE
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State | AZ
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Zip | 85283-3039
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Country | US
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Telephone | 480-275-2221
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Fax | 480-361-6471
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Provider Business Mailing Address
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Address Line | 1046 E WESTCHESTER DR
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City | TEMPE
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State | AZ
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Zip | 85283-3039
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Country | US
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Telephone | 480-275-2221
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Fax | 480-361-6471
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Authorized Official
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Title or Position | MANAGER/OWNER
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Name | MRS. SOPHIA SAMANTHA QENDRO
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Credential |
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Telephone | 480-275-2221
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305S00000X
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Taxonomy Name | Point of Service
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License Number | AL9833H
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License Number State | AZ
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