=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427640028
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ABSOLUTE HCBS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/05/2021
-----------------------------------------------------
Last Update Date | 02/05/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4700 S MCCLINTOCK DR STE 150
-----------------------------------------------------
City | TEMPE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85282-7375
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 623-806-4040
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4700 S MCCLINTOCK DR STE 150
-----------------------------------------------------
City | TEMPE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85282-7375
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 623-806-4040
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/CFO
-----------------------------------------------------
Name | COURTNEY MISTICO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 623-806-4040
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3747A0650X
-----------------------------------------------------
Taxonomy Name | Attendant Care Provider
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 376J00000X
-----------------------------------------------------
Taxonomy Name | Homemaker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 385H00000X
-----------------------------------------------------
Taxonomy Name | Respite Care
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 373H00000X
-----------------------------------------------------
Taxonomy Name | Day Training/Habilitation Specialist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------