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General NPI Number Information
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NPI Number | 1497587554
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Entity Type | Organization
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Legal Business Name | KOCCH HAVEN LLC
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Dates
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Enumeration Date | 08/16/2024
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Last Update Date | 08/16/2024
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Provider Practice Location Address
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Address Line | 6428 S 23RD AVE
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City | PHOENIX
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State | AZ
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Zip | 85041-5357
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Country | US
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Telephone | 832-513-5993
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Fax |
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Provider Business Mailing Address
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Address Line | 21289 S 187TH WAY
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City | QUEEN CREEK
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State | AZ
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Zip | 85142-3668
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Country | US
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Telephone | 832-513-5993
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Fax |
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Authorized Official
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Title or Position | MEMBER MANAGER
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Name | CHIKODILI C UBA
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Credential | RN
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Telephone | 832-513-5993
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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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 | 385H00000X
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Taxonomy Name | Respite Care
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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 | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State |
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